title: Tobacco control policies specified according to socioeconomic status: health disparities and cost-effectiveness.
abstract: BACKGROUND
  Little is known about the cost-effectiveness of tobacco control policy for different socioeconomic status (SES) groups. We aimed to evaluate SES-specific cost-effectiveness ratios of policies with known favorable effect in low-SES groups: a tobacco tax increase and reimbursement of cessation support.
  
  
  METHODS
  A computer model of the adult population specified by smoking behavior (never/current/former smoker), age, gender, and SES simulated policy scenarios reflecting the implementation of a €0.22 tobacco tax increase or full reimbursement of cessation support, which were compared. Relating differences in costs to quality-adjusted life years (QALYs) gained generated cost-effectiveness ratios for each SES group.
  
  
  RESULTS
  In a cohort of 11 million people, the tobacco tax increase resulted in 27,000 additional quitters after 5 years, who were proportionally divided among the SES groups. Reimbursement led to 59,000 additional quitters, with relatively more quitters in higher-SES groups. The number of QALYs gained were 3,400-6,200 among the various SES groups for the tax increase and 6,300-14,000 for the reimbursement scenario. For both interventions, favorability of the cost-effectiveness ratios increased with SES: costs per QALY decreased from €6,100 to €4,500 for the tax increase and from €21,000 to €11,000 for reimbursement.
  
  
  CONCLUSIONS
  The reimbursement policy produced the greatest overall health gain. Surprisingly, neither tax increase nor reimbursement reduced health disparities. Differences in use were too small to compensate for improved health gains per quitter among higher-SES groups. Both policies qualified as cost-effective overall, with more favorable cost-effectiveness ratios for high-SES than for low-SES groups.
authors.affiliation: Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands;
authors.forename: Eelco A B
authors.initials: EA
authors.lastname: Over
authors.forename: Talitha L
authors.initials: TL
authors.lastname: Feenstra
authors.forename: Rudolf T
authors.initials: RT
authors.lastname: Hoogenveen
authors.forename: Mariël
authors.initials: M
authors.lastname: Droomers
authors.forename: Ellen
authors.initials: E
authors.lastname: Uiters
authors.forename: Boukje M
authors.initials: BM
authors.lastname: van Gelder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D006291:Health Policy; D006293:Health Promotion / Q000191:economics / Q000379:methods; D054624:Health Status Disparities; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008875:Middle Aged; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000191:economics*; D016540:Smoking Cessation / Q000191:economics*; D000074606:Smoking Prevention; D012923:Social Class; D012926:Social Control, Formal / Q000379:methods*; D013660:Taxes / Q000191:economics