Economic Evaluation to Inform Health Policy: Cost-Effectiveness and Policy Analysis of Tobacco Control Interventions in Vietnam

• Main Author: Higashi, Hideki
• Format: Thesis
• Language: unknown
• Published: The University of Queensland, School of Population Health 2011
• Subjects: Vietnam; Tobacco; Smoking; Health Policy; Cost-Effectiveness; Economic Evaluation; Economic Analysis; Health Priorities; Evidence; 11 Medical and Health Sciences; First Nations
• Online Access: https://espace.library.uq.edu.au/view/UQ:252232/s4155000_phd_finalthesis.pdf; https://espace.library.uq.edu.au/view/UQ:252232

Background Vietnam has one of the highest smoking rates in the world. Findings from national surveys suggest the rate of smoking among male adults is higher than 50%. In 2000, the government of Vietnam issued a resolution; the National Tobacco Control Policy 2000-2010. The resolution was a manifestation of the government’s commitment to combat the tobacco epidemic in Vietnam. Since its inception, a number of decrees and decisions have been issued to implement the policy. In 2004, Vietnam was one of the first nations in the region to ratify the Framework Convention on Tobacco Control (FCTC), and the action plan for its implementation was subsequently launched in 2009. Despite the apparent vigour with which the government of Vietnam has responded to the international agenda on tobacco control, progress with legislation and implementation has been slow. This thesis comprises three research components which collectively aim to provide policy makers with an evidence-base on which to prioritise interventions to reduce tobacco related morbidity and mortality for the first time in Vietnam. Component 1: Policy analysis The first component provides insight of the key stakeholders and their perceptions, the decision-making process, and the role of evidence in the process of tobacco control policy and legislation in Vietnam. A literature review and documentary analysis, key informant interviews and focus group discussion, and a key stakeholders survey were conducted for the analysis. The Ministry of Health, the Ministry of Trade and Industry, and the Ministry of Finance were identified as key players in the tobacco control policy and legislation processes, all representing competing bureaucratic interests. The Communist Party and the National Assembly take a rather relaxed position, which reflects the low political priority placed on tobacco issues. Bureaucratic power relationships dominate the decision-making process of tobacco control policy. Generally, the political environment is not very favourable for tobacco control policy. International pressure on tobacco control is not as salient as in other priority health issues like HIV/AIDS. However, positive signs have been observed since the ratification of the FCTC. Evidence is considered important in the policy process, but evidence from high-income countries is often viewed with scepticism as to its applicability to Vietnam. The main concern of policy makers in the decision-making process is the deficient evidence of socio-economic implications associated with tobacco control interventions. Component 2: Economic evaluation and analysis The second component provides evidence on the cost-effectiveness of five tobacco control interventions targeted at the population level and five interventions to support smoking cessation at the individual level. A multi-state life table model was constructed in Microsoft Excel. Government and health care perspectives were adopted with costing conducted using a bottom-up approach. The 2006 population was followed up in order to model the costs and health gains associated with the interventions. Health improvement was considered in terms of disability-adjusted life years (DALYs) averted. An economic analysis was conducted to investigate the government revenue implications of an excise tax increase to supplement the cost-effectiveness findings. All interventions targeted at the population level were “very cost-effective” according to the threshold level suggested by the World Health Organization (i.e.