Evaluation of the economic impact of California's Tobacco Control Program: a dynamic model approach.
OBJECTIVE
To evaluate the long-term net economic impact of the California Tobacco Control Program.


METHODS
This study developed a series of dynamic models of smoking-caused mortality, morbidity, health status and healthcare expenditures. The models were used to evaluate the impact of the tobacco control programme. Outcomes of interest in the evaluation include net healthcare expenditures saved, years of life saved, years of treating smoking-related diseases averted and the total economic value of net healthcare savings and life saved by the programme. These outcomes are evaluated to 2079. Due to data limitations, the evaluations are conducted only for men.


RESULTS
The California Tobacco Control Program resulted in over 700,000 person-years of life saved and over 150,000 person-years of treatment averted for the 14.7 million male California residents alive in 1990. The value of net healthcare savings and years of life saved resulting from the programme was $22 billion or $107 billion in 1990 dollars, depending on how a year of life is discounted. If women were included, the impact would likely be much greater.


CONCLUSIONS
The benefits of California's Tobacco Control Program are substantial and will continue to accrue for many years. Although the programme has resulted in increased longevity and additional healthcare resources for some, this impact is more than outweighed by the value of the additional years of life. Modelling the programme's impact in a dynamic framework makes it possible to evaluate the multiple impacts that the programme has on life, health and medical expenditures.
Miller
Leonard S
LS
School of Social Welfare, University of California, Berkeley, California, USA.
Max
Wendy
W
Sung
Hai-Yen
HY
Rice
Dorothy
D
Zaretsky
Malcolm
M
D002140:California / Q000453:epidemiology; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008136:Longevity; D008297:Male; D017059:Models, Econometric; D009026:Mortality / Q000639:trends*; D015397:Program Evaluation; D012907:Smoking / Q000191:economics / Q000401:mortality; D000074606:Smoking Prevention; D020340:Tobacco Use Cessation / Q000191:economics* / Q000706:statistics & numerical data; D014026:Nicotiana
Cancer Epidemiol Biomarkers Prev. 1993 Nov-Dec;2(6):593-7
8268779
Ann Epidemiol. 2002 Apr;12(3):141-50
11897171
Tob Control. 2007 Apr;16(2):85-90
17400944
Cancer Causes Control. 2004 Sep;15(7):689-95
15280627
Am J Public Health. 2002 Jun;92(6):990-6
12036794
Am J Health Promot. 2000 Nov-Dec;15(2):81-8
11194699
Public Health Rep. 1998 Sep-Oct;113(5):447-58
9769770
PLoS Med. 2008 Aug 26;5(8):e178
18752344
Milbank Q. 1992;70(1):81-125
1588892
MMWR Morb Mortal Wkly Rep. 1994 Jul 8;43(26):469-72
8007931
JAMA. 1989 Mar 17;261(11):1604-9
2918654
J Natl Cancer Inst. 1996 Dec 4;88(23):1748-58
8944005
Tob Control. 2004 Sep;13(3):264-7
15333882
Annu Rev Public Health. 2002;23:45-71
11910054
Tob Control. 1999 Autumn;8(3):290-300
10599574
Health Aff (Millwood). 1996 Spring;15(1):58-72
8920569
J Health Econ. 2003 Sep;22(5):843-59
12946462
BMJ. 2004 Jun 26;328(7455):1519
15213107
JAMA. 1994 Feb 23;271(8):608-11
8301793
Am J Public Health. 2002 Jun;92(6):975-83
12036792
Soc Sci Med. 1999 Feb;48(3):375-91
10077285
N Engl J Med. 1997 Oct 9;337(15):1052-7
9321534
Soc Sci Med. 1983;17(23):1907-14
6419350
JAMA. 1998 Sep 9;280(10):893-9
9739973
MMWR Morb Mortal Wkly Rep. 1995 Jul 21;44(28):521-5
7603427
Tob Control. 1997 Summer;6(2):122-7
9291221
Am J Health Promot. 2001 May-Jun;15(5):321-31
11502013
Am J Epidemiol. 1994 Sep 15;140(6):535-43
8067347
N Engl J Med. 2000 Dec 14;343(24):1772-7
11114317
Tob Control. 2006 Aug;15(4):308-16
16885580
Hum Genet. 1981;59(1):39-46
10819020
J Gerontol A Biol Sci Med Sci. 2003 Jun;58(6):566-72
12807930