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Report on Smoking Cessation

Submitted by : Asma Bashir

Submitted to : Dr. Bilal
ROLL NO: 104.7.2017
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Department of Economics, GCUL

 Smoking cessation

Introduction
Smoking cessation (quitting smoking) is the process of discontinuing tobacco smoking. Tobacco
contains nicotine, which is addictive. Nicotine makes the process of quitting often very
prolonged and difficult. Smoking is the leading preventable cause of death worldwide, and
quitting smoking significantly reduces the risk of dying from tobacco-related diseases such as
heart disease and lung cancer. Seventy percent of smokers would like to quit smoking, and 50
percent report attempting to quit within the past year.

Tobacco use is a major cause of preventable illness and death. Quitting smoking is one of the
best things you can do for your health, and there are many resources available to help
you.Goverments of different countries try to reduce smokers in their respective countries through
different programs, as smokers helpline program, quitting smoking program, proving free
medicines to smokers so they can stop smoking.

Imagine that as a cost benefit analyst, CBA analyst has to work for Lahore district, Punjab
Pakistan, and to perform a CBA of a proposed program that is to provide counselling and
education in Lahore district areas. The program is called education and counselling program. The
program addresses different sections of societies, in this CBA analyst has taken three sections.
First, aged, blind and disabled persons program, second family program and third pregnant
women program and will see the impact of education and counseling program on these different
sections of society

CBA analyst will do the CBA analysis through the following steps.

Specifying set of alternative projects

It requires the analyst to specify set of alternative projects.
In this CBA analyst has two alternatives, providing one area with education and counselling and
one with no counselling and education. For, many projects no of alternatives are there, so in this
smoking cessation program the alternatives are as following.

Interventions

 Policies making workplace and public places smoke-free.

 Voluntary rules making homes smoke-free, which are thought to promote smoking
cessation.
 Initiatives to educate the public regarding the health effects of second-hand smoke,
including the significant dangers of secondhand smoke infiltration for residents of multi-
unit housing.

“Secondhand smoke is a mixture of the smoke that comes from the burning end of a
cigarette, cigar, or pipe, and the smoke breathed out by the smoker. It contains more than
7,000 chemicals. Hundreds of those chemicals are toxic and about 70 can cause cancer.”

Other alternatives could be,

Quitting Aid How To Use It

Nicotine patch Stick to skin on upper body. Follow directions carefully.

Chew briefly. Then place it between cheek and gum. Follow

Nicotine gum
directions carefully.

Nicotine inhaler or nasal Inhaler: inhale through mouth.

spray Spray: spray into the nose. Follow directions carefully.

Dissolve in mouth slowly, one at a time. Follow directions

Nicotine lozenges
carefully.

Prescription pills (Zyban, Take pill prescribed by doctor. Start 1-2 weeks before quitting
Chantix) smoking.
Cost of providing smoking cessation services
To estimate the costs of providing smoking cessation services to Medicaid enrollees, it is first
necessary to identify an effective set of cessation services. More extensive counseling and use of
pharmaceutical therapies increase the cost of treatment and the likelihood of successfully
quitting. The more successful the treatment, the greater the number of individuals with
improvements in health status and the greater the reduction in smoking-related health care
expenditures, at least in the short-term.

The costs for these selected treatments are displayed in table 1- 2. The cost estimates assume
each person attempting to quit smoking makes only one attempt per year and that smoking
cessation services are offered for one year only.

To complete the information needed to estimate total costs in Table 1- 2, data are needed on
overall caseloads, number of smokers, and number of smokers expected to make a quit attempt
and receive treatment.

As three different groups of the society are taken for the cost benefit analysis. The three groups
are aged, blind and disabled, second are the family group and the third one is the pregnant ladies
of the society in district Lahore. So, below are some tables showing the costs and benefits of
these groups.

Table 1-1 shows the estimated costs of smoking cessation program of blind, disabled and aged
group of district Lahore.
Total estimated district Lahore costs

Selected smoking program (education and counselling)

Table 1-1 Aged, blind, disabled program

Services No. of individuals Per-person cost Total cost

Cost common to
all treatments
Screening 163,200 3$ 4,90,000$
Advice, motivation 53,400 13$ 6,94,000$
Treatment costs

Minimal 27,800 15$ 4,17,000$

counseling 27,800 549$ 8,050,000$
Full counseling

Overall costs

Minimal 1,601,000$
counseling & 9,234,000$
education
Full counseling and
education
Total estimated district Lahore costs

Selected smoking program (education and counselling)

Table 1-2 Family Programs

Services No. of individuals Per-person cost Total cost

Cost common to
all treatments

67,000 3$ 203,000$
Screening 22,100 13$ 287,000$
Advice, motivation
Treatment costs

Minimal
11,500 15$ 1,73,000$
counseling
11,500 549$ 3,337,000$
Full counseling

Overall costs

Minimal
6.63.000$
counseling
3,827,000$
Full counseling
Total estimated district Lahore costs

Selected smoking program (education and counselling)

Table 1-3 pregnant women Program

Services No. of individuals Per-person cost Total cost

Cost common to
all treatments
Screening 35,500 3$ 1,07,000$

Add. cost for brief

counseling
Advice, motivation 7,400 22,000$
3$

Treatment costs

Minimal
4,400 11$ 48,000$
counseling
4,400 13$ 57,000$
Full counseling

Overall costs

Minimal
1.55.000$
counseling
1,86,000$
Full counseling
Benefits of smoking cessation services
The potential benefits from smoking cessation occur over an extended period of time. Recent
research identifies two types of short-term benefits associated with smoking cessation. For all
persons, the risk of heart attack and stroke declines rapidly once they stop smoking. This
translates into fewer hospitalizations, even one year after quitting, and therefore reduced health
care expenditures in the short-term.

Life expectancy increases and also more lives area saved.

As expenditures on health rea less, so people can save more.

Savings associated with pregnant women would primarily occur in the first year of a newborn’s
life. When mothers quit smoking, there would also be two additional but smaller sources of
health care savings over time. First are the ongoing savings that occur over the remainder of a
child’s life, and second are any savings associated with reduced risk of heart attack and stroke.

For pregnant women, smoking is strongly related to low birth weight infants for whom the risk
of illness and death is increased relative to normal birth weight babies. Therefore, because
smoking cessation among pregnant women leads to fewer low birth weight infants, it reduces
health care costs for newborns and infants in the short-term. In addition, those women who do
not resume smoking after pregnancy benefit from the same reduction in the risk of heart attack
and stroke as do other adult quitters.

There are additional, although much smaller, health care costs that would be avoided over the
remainder of a low birth weight child’s life.
Total estimates district Lahore Benefits

Selected Smoking Cessation Programs (Education and counseling)

Table 1-4 Benefits of smoking cessation program

Projects Benefits After 2year Next 2 years Other 2 years

Aged, blind ,disabled 209$ 737$ 1,350$
program

753$
Family program 134$ 429$
138$
Pregnant women 490$ 243$
program

Decide whose benefits and costs counts

Next, CBA analyst has to decide whose costs and benefits should be counted. Costs and benefits
of those are counted having services provided by the government. Because those who are not
having any kind of service as counseling and education are having no costs. So could not be
counted. The areas in which the program is initiated, their costs and benefits are counted. As we
can see the benefits with the program are more than benefits with no program.

Catalogue the impacts and select the measurement indicator

In this CBA analyst has to list the physical impacts of alternatives as benefits or costs to specify
the measurement indicators. The term impacts are used broadly to include both the inputs and the
outputs. For the proposed counseling and education program, the anticipated benefits are the
savings of people, as expenditures on health are reduced and the lives saved. As people are
quitting smoking so those who are dying due to heart strokes and lungs, their lives are saved.

Predict the impacts quantitatively over the life of a project

Smoking cessation program (Education n counseling), like all other projects has its impacts that
extend over time. The fourth task is to quantify all impacts for each alternative in each time
period. CBA analyst will make predictions for the areas where counseling is provided and where
it is not, for each year, and for each category of individuals about

 The number of individuals ready to quit smoking.

 The number of individuals who actually did it.

With these estimates, and with other information, the analyst can estimate

 The amount of money people saved, as they are healthy now

 The effect of their smoking on others was reduced
 The number of heart attack and strokes declines
 The number of lives saved

Monetize dollar value to each impact

The analyst next has to monetize each of the impacts. To monetize means to value in dollars. For
example, in this project, CBA analyst has to monetize each unit of life saved; money saved and
reduced heart attacks. For this, the analyst need the monetary value of decline in heart attacks,
the value of statistical life saved and money saved. Some of the dollar values used in CBA is,

 Value of a life saved = $500,000 per life

 Money saved (per person) = $1,00,000
 Decline in strokes and heart attack = $75,000

Some government agencies and critics of CBA are unwilling to attach a monetary value to life or
some other impact. This forces them to use an alternative method of analysis, such as cost-
effectiveness analysis or multigoal analysis.
Discount benefits and costs to obtain present values
For a project, that has costs and benefits that accrue over extended periods (years), we need a
way to aggregate the benefits and costs that arises in different years. In CBA, future benefits and
costs are discounted relative to present benefits and costs in order to obtain their present value
PV. Discounting has to do nothing with the inflation per se, although inflation must be taken in
to account.

A cost or benefit that occur in year t is converted to its present value by dividing by (1+s) ^t,
where s is the social discount rate. Suppose a project has a life of n years and let Bt and Ct
denotes the benefits and costs in year t, respectively. The present value of benefits, PV (B), and
the present value of costs, PV (C), of the project are respectively.

PV (B) = ∑ Bt/ (1+s) ^t

PV (C) =∑ Ct/ (1+s) ^t

Compute the net present value

The net present value of an alternative, NPV, equals the difference between the present value of
its benefits and the present value of the costs:

NPV = PV (B) – PV(C)

The basic decision rule for a single alternative is simple: adopt the project if its NPV is positive.
In short, the analyst should recommend proceeding with the project if it’s NPV = PV (B) – PV
(C) >0 that is, if PV (B) > PV (C) _ its benefits exceeds costs.

Table 1-5 shows the estimated costs and benefits, at the individual level, of two smoking
cessation treatments for each Medicaid group of interest. Costs are equal to total Medicaid
smoking cessation expenses divided by the number of attempts to quit smoking. Benefits are
equal to the average Medicaid expenditures that would be avoided if a smoker successfully quits.
 Table 1-5 estimated costs and benefits: selected smoking program

Cost Qui Biennium1 Biennium2 Bienium3 NPV Quit Benefit

per 2 attempt cost
quit 4 ratio
1
Aged
program
Min. 58$ .4% 209$ 737$ 1350$ 2067$ 7.6$ 0.13$
Counseling
Full 332$ 5% 209$ 737$ 1350$ 2067$ 106.3$ 0.32$
counseling
Family
program
Min. 58$ .4% 134$ 429$ 733$ 1170$ 4.3$ 0.07$
counseling
Full 332$ 5% 134$ 429$ 733$ 1170$ 60.2$ 0.18$
counseling
women
program
Brief 35$ 2% 490$ 243$ 138$ 820$ 16.3$ 0.4$
counseling
1
Brief 42$ 3% 490$ 243$ 138$ 820$ 24.2$ 0.5$
counseling
2
Sensitivity analysis of estimates
Next step is to perform the sensitivity analysis of the estimates. To test the sensitivity of cost and
savings estimates to changes in assumptions about the number of smokers in a group, success
rates of treatment, and other key parameters, we have estimated costs and savings under several
alternate scenarios for the Pregnant Women group.

Given the large disparity between costs and savings for the other two groups (Aged, Blind, and
Disabled and Work First/Family Medical), no reasonable change in assumptions would alter the
qualitative conclusion that the net impact of smoking cessation increases Medicaid expenditures.
However, the costs and savings for pregnant women appear to be close enough to warrant further
investigation.

Table 1-6 presents a number of alternative estimates of the costs and benefits of smoking
cessation under changes to key smoking-related parameters. If the percentage of smokers willing
to make a quit attempt is actually higher, this has impacts on both costs and benefits.

When more individuals receive smoking cessation treatment, total Medicaid costs increase.
However, the cost per quit attempt actually goes down. This results from spreading the costs of
two activities, screening for tobacco use and advising smokers to quit, over a larger number of
quit attempts. The benefits (avoided Medicaid costs) per successful quitter remain the same, but,
because more individuals are attempting to quit, there are more successes. Therefore, total
Medicaid benefits increase.
 Table 1-6 Sensitivity Analysis

Costs and Benefits of Cessation Treatment for Pregnant Women

Cost % of Estimated Estimated Benefit/co Change

per successfu benefits benefits st in
attempt l attempt per per quit ratio benefit/c
successful attempt ost ratio
quitter
Baseline 39$ 3% 820$ 24$ 0.62$ -
estimates
Increase 47$ 3% 820$ 24$ 0.52$ (0.10)$
treatment costs
by 20%
Decrease costs 31$ 3% 820$ 24$ 0.78$ 0.16$
by 20%
Increase quit 33$ 3% 820$ 24$ 0.73$ 0.11$
attempt to 75%
Decrease to 47$ 3% 820$ 24$ 0.52$ (0.11)$
45%
Increase success 39$ 3.7% 820$ 30$ 0.78$ 0.16$
rate by 25%
Decrease by 39$ 2.2% 820$ 18$ 0.47$ (0.16)$
25%
Conclusion
The adoption of smoking cessation treatment program would cost more than it saves, regardless
of which group is considered, when viewed from the standpoint of short-term impacts. The
reduction in preventable deaths, increase in years of life, and potential reduction in lifetime
health care expenditures attributable to smoking cessation are all desirable outcomes. However,
when smoking cessation treatments are provided to Medicaid enrollees, all of the costs—but only
a fraction of these savings—accrue to the program. The bottom line is that smoking cessation
programs may be able to achieve long-term social benefits, but the programs do not appear to be
able to save more than they cost for the short-term state budget.

Recommendations

 Recommendations that primary care clinicians provide interventions, including education

or brief counseling, to prevent initiation of tobacco use in school-aged children and
adults..
 Increasing the price of tobacco products, for example by taxation.
 Mass media campaigns. (awareness through media)
 Institutional level smoking bans. For example, in schools and colleges etc.
 Providing free medical treatment to smokers.
 Government should inform you of health improvements and offers games to distract
from cravings, in the stage of quitting smoking it will help a lot.