Predictors of smoke‐free workplaces by employee characteristics: Who is left unprotected?

BACKGROUND: Over the last decade, there has been steady progress in the adoption of workplace smoking policies in the United States. However, the benefits of a smoke-free workplace are not distributed equally among the workforce. METHODS: Data from 44,357 adults who reported that they work indoors were derived from an optional tobacco module on the 2001 Behavioral Risk Factor Surveillance System (BRFSS), administered by 25 states. Logistic regression was utilized to examine factors associated with the absence of a smoke-free workplace policy. RESULTS: Overall, 70.9% of respondents reported working under a smoke-free workplace policy. The likelihood of being protected by a smoke-free workplace policy was significantly lower among workers who were younger, male, non-white, engaged in heavy labor, earned less than 50,000 US dollars annually, had a high school education or less, smoked everyday, or worked in the South or Midwest. CONCLUSIONS: There remain considerable gaps in smoke-free workplace policy coverage.     

Use of pharmacy data to evaluate smoking regulations' impact on sales of nicotine replacement therapies in New York City

OBJECTIVES: Recently, New York City and New York State increased cigarette excise taxes and New York City implemented a smoke-free workplace law. To assess the impact of these policies on smoking cessation in New York City, we examined over-the-counter sales of nicotine replacement therapy (NRT) products. METHODS: Pharmacy sales data were collected in real time as part of nontraditional surveillance activities. We used Poisson generalized estimating equations to analyze the effect of smoking-related policies on pharmacy-specific weekly sales of nicotine patches and gum. We assessed effect modification by pharmacy location. RESULTS: We observed increases in NRT product sales during the weeks of the cigarette tax increases and the smoke-free workplace law. Pharmacies in low-income areas generally had larger and more persistent increases in response to tax increases than those in higher-income areas. CONCLUSIONS: Real-time monitoring of existing nontraditional surveillance data, such as pharmacy sales of NRT products, can help assess the effects of public policies on cessation attempts. Cigarette tax increases and smoke-free workplace regulations were associated with increased smoking cessation attempts in New York City, particularly in low-income areas.     

State-specific trends in smoke-free workplace policy coverage: the current population survey tobacco use supplement, 1993 to 1999

We examined trends in smoke-free workplace policies among all indoor workers in the United States using the National Cancer Institute's Tobacco Use Supplement to the Census Bureau's Current Population Survey (total n = 270,063). Smoke-free was defined as smoking not permitted in public or common areas or in work areas of a worksite. Nationally, we found that nearly 70% of the US workforce worked under a smoke-free policy in 1999. At the state level, a greater than 30-percentage-point differential existed in the proportion of workers with such policies. Although significant progress has been made to reduce worker exposure to environmental tobacco smoke on the job, we predict further progress may be difficult unless comprehensive regulations to protect all workers are implemented at the national, state, or local level.     

Comprehensive Smoke-Free Policies: A Tool for Improving Preconception Health?

Lower income women are at higher risk for preconception and prenatal smoking, are less likely to spontaneously quit smoking during pregnancy, and have higher prenatal relapse rates than women in higher income groups. Policies prohibiting tobacco smoking in public places are intended to reduce exposure to secondhand smoke; additionally, since these policies promote a smoke-free norm, there have been associations between smoke-free policies and reduced smoking prevalence. Given the public health burden of smoking, particularly among women who become pregnant, our objective was to assess the impact of smoke-free policies on the odds of preconception smoking among low-income women. We estimated the odds of preconception smoking among low-income women in Ohio between 2002 and 2009 using data from repeated cross-sectional samples of women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). A logistic spline regression was applied fitting a knot at the point of enforcement of the Ohio Smoke-free Workplace Act to evaluate whether this policy was associated with changes in the odds of smoking. After adjusting for individual- and environmental-level factors, the Ohio Smoke-free Workplace Act was associated with a small, but statistically significant reduction in the odds of preconception smoking in WIC participants. Comprehensive smoke-free policies prohibiting smoking in public places and workplaces may also be associated with reductions in smoking among low-income women. This type of policy or environmental change strategy may promote a tobacco-free norm and improve preconception health among a population at risk for smoking.     

The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop

Background

The txt2stop trial has shown that mobile-phone-based smoking cessation support doubles biochemically validated quitting at 6 months. This study examines the cost-effectiveness of smoking cessation support delivered by mobile phone text messaging.

Methods

The lifetime incremental costs and benefits of adding text-based support to current practice are estimated from a UK NHS perspective using a Markov model. The cost-effectiveness was measured in terms of cost per quitter, cost per life year gained and cost per QALY gained. As in previous studies, smokers are assumed to face a higher risk of experiencing the following five diseases: lung cancer, stroke, myocardial infarction, chronic obstructive pulmonary disease, and coronary heart disease (i.e. the main fatal or disabling, but by no means the only, adverse effects of prolonged smoking). The treatment costs and health state values associated with these diseases were identified from the literature. The analysis was based on the age and gender distribution observed in the txt2stop trial. Effectiveness and cost parameters were varied in deterministic sensitivity analyses, and a probabilistic sensitivity analysis was also performed.

Findings

The cost of text-based support per 1,000 enrolled smokers is £16,120, which, given an estimated 58 additional quitters at 6 months, equates to £278 per quitter. However, when the future NHS costs saved (as a result of reduced smoking) are included, text-based support would be cost saving. It is estimated that 18 LYs are gained per 1,000 smokers (0.3 LYs per quitter) receiving text-based support, and 29 QALYs are gained (0.5 QALYs per quitter). The deterministic sensitivity analysis indicated that changes in individual model parameters did not alter the conclusion that this is a cost-effective intervention. Similarly, the probabilistic sensitivity analysis indicated a >90 % chance that the intervention will be cost saving.

Interpretation

This study shows that under a wide variety of conditions, personalised smoking cessation advice and support by mobile phone message is both beneficial for health and cost saving to a health system.     

‘If I pay rent,I’m gonna smoke’: Insights on the social contract of smokefree housing policy in affordable housing settings

Smoke-free housing policy in multi-unit housing has emerged as a promising tobacco control initiative, yet full compliance remains elusive and is a critical impediment to policy effectiveness. There is a gap in existing research on potential factors preventing optimal smoke-free policy adoption and corresponding solutions. Using qualitative and quantitative data from resident surveys (N = 115) as well as key informant interviews, a focus group, and observational fieldwork, this study 1) assesses smoking behaviors and experience with secondhand smoke in buildings after adoption of a smoke-free policy; 2) examines resident and property management perceptions of the policy; and 3) identifies socioecological factors that influence the policy's effectiveness in affordable housing settings in New York City. Findings indicate that residents view smoking regulations within the context of broader relationships with the housing provider and other residents. We argue that these “social contracts” strongly influence the effectiveness of smoke-free housing policies and must be acknowledged to maximize compliance.     

The cost of antiretroviral therapy in Haiti

Background

Tobacco smoking is a risk factor for age-related macular degeneration, but studies of ex-smokers suggest quitting can reduce the risk.

Methods

We fitted a function predicting the decline in risk of macular degeneration after quitting to data from 7 studies involving 1,488 patients. We assessed the cost-effectiveness of smoking cessation in terms of its impact on macular degeneration-related outcomes for 1,000 randomly selected U.S. smokers. We used a computer simulation model to predict the incidence of macular degeneration and blindness, the number of quality-adjusted life-years (QALYs), and direct costs (in 2004 U.S. dollars) until age 85 years. Cost-effectiveness ratios were based on the cost of the Massachusetts Tobacco Control Program. Costs and QALYs were discounted at 3% per year.

Results

If 1,000 smokers quit, our model predicted 48 fewer cases of macular degeneration, 12 fewer cases of blindness, and a gain of 1,600 QALYs. Macular degeneration-related costs would decrease by $2.5 million if the costs of caregivers for people with vision loss were included, or by $1.1 million if caregiver costs were excluded. At a cost of $1,400 per quitter, smoking cessation was cost-saving when caregiver costs were included, and cost about $200 per QALY gained when caregiver costs were excluded. Sensitivity analyses had a negligible impact. The cost per quitter would have to exceed $77,000 for the cost per QALY for smoking cessation to reach $50,000, a threshold above which interventions are sometimes viewed as not cost-effective.

Conclusion

Smoking cessation is unequivocally cost-effective in terms of its impact on age-related macular degeneration outcomes alone.     

Cost-Effectiveness of Face-to-Face Smoking Cessation Interventions: A Dynamic Modeling Study

OBJECTIVES: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in terms of costs per quitter, costs per life-year gained, and costs per quality-adjusted life-year (QALY) gained. METHODS: Scenarios on increased implementation of smoking cessation interventions were compared with current practice in The Netherlands. One of the five interventions was implemented for a period of 1, 10, or 75 years reaching 25% of the smokers each year. A dynamic population model, the RIVM chronic disease model, was used to project future gains in life-years and QALYs, and savings of health-care costs from a decrease in the incidence of 11 smoking-related diseases over a time horizon of 75 years. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size, and discount rates. RESULTS: Compared with current practice, minimal GP counseling was a dominant intervention, generating both gains in life-years and QALYs and savings that were higher than intervention costs. For the other interventions, incremental costs per QALY gained ranged from about 1100 per thousand for telephone counseling to 4900 per thousand for intensive counseling with nicotine patches or gum for implementation periods of 75 years. CONCLUSIONS: All five smoking cessation interventions were cost-effective compared with current practice, and minimal GP counseling was even cost-saving.     

Quitline in smoking cessation: a cost-effectiveness analysis

OBJECTIVES: The cost-effectiveness of the Swedish quitline, a nation-wide, free of charge service, is assessed. METHODS: The study was based on data of a sample of 1131 callers enrolled from February 1, 2000 to November 30, 2001. Outcome was measured as cost per quitter and cost per year of life saved. Cost per quitter was based on a calculation of the total cost of the quitline divided by the number of individuals who reported abstinence after 12 months. The cost per life year saved (LYS) was calculated by the use of data from the literature on average life expectancy for smokers versus quitters, the total cost of the quitline, and the cost of pharmacological treatment. RESULTS: The number of smokers who used the quitline and reported abstinence after 1 year was 354 (31 percent). The accumulated number of life years saved in the study population was 2400. The cost per quitter was 1052-1360 USD, and the cost per life year saved was 311-401 USD. A sensitivity analysis showed that, for outcomes down to an abstinence rate of 20 percent, the cost per LYS rose modestly, from 311 to 482 USD. Discounting the cost per LYS showed the cost to be 135 USD for 3 percent and 283 USD for 5 percent. CONCLUSIONS: The Swedish quitline is a cost-effective public health intervention compared with other smoking cessation interventions.     

Financial burden of tobacco use: an employer's perspective

To assist in determining whether employer-sponsored smoking cessation programs can be justified on cost-effectiveness grounds, a review was performed to examine the costs imposed on employers by smoking and the extent to which employers can recover those costs through successful smoking cessation programs. The magnitude of the costs (or cost savings) imposed by employee tobacco use depends on workplace factors, including medical coverage (before and after retirement), disability and life insurance benefits, level of exposure to workplace pollutants associated with smoking-related diseases, employee turnover rate, current smoke-free area policy, smoking breaks policy, cost of providing smoking areas, and type of retirement pension plan.     

Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence

Objectives. We sought to assess the impact of several tobacco control policies and televised antismoking advertising on adult smoking prevalence.Methods. We used a population survey in which smoking prevalence was measured each month from 1995 through 2006. Time-series analysis assessed the effect on smoking prevalence of televised antismoking advertising (with gross audience rating points [GRPs] per month), cigarette costliness, monthly sales of nicotine replacement therapy (NRT) and bupropion, and smoke-free restaurant laws.Results. Increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence. We found a 0.3-percentage-point reduction in smoking prevalence by either exposing the population to televised antismoking ads an average of almost 4 times per month (390 GRPs) or by increasing the costliness of a pack of cigarettes by 0.03% of gross average weekly earnings. Monthly sales of NRT and bupropion, exposure to NRT advertising, and smoke-free restaurant laws had no detectable impact on smoking prevalence.Conclusions. Increases in the real price of cigarettes and tobacco control mass media campaigns broadcast at sufficient exposure levels and at regular intervals are critical for reducing population smoking prevalence.Population-wide interventions that can reduce adult smoking prevalence are important for curbing the pandemic of tobacco-related disease.1^–3 However, evaluating the effects of tobacco control policies and mass media interventions on populations is difficult.4^,5 Generally, there are few comparable control populations to which policy or media interventions are not delivered. Tobacco policies and media campaigns often co-occur, complicating assessment of the relative contribution of each. In addition, most studies in which smoking prevalence is the outcome measure rely on annual population surveys to track change over time, despite policy and media interventions being generally implemented throughout the year, and at differing strengths relative to the time of survey administration. Small or transient impacts on smoking prevalence are difficult to detect and may be underestimated.Over the past decade, the Australian population has been exposed to changes in several tobacco control policies, including changes in taxes on tobacco products resulting in increases in the real price of cigarettes, increasing availability of pharmaceutical smoking cessation products such as nicotine replacement therapies (NRT) and bupropion, and the introduction of smoke-free restaurant laws. In addition, there has been considerable variation in exposure to public health–sponsored mass media campaigns and pharmaceutical advertising for NRT. We have assessed the independent effect of each tobacco control policy and type of media campaign with a data series in which self-reported smoking prevalence was measured every month over a period of 11 years. This method has the advantage over annual population surveys of more closely matching the timing and extent of policy implementation and media exposure to smoking prevalence, and it has the ability to examine the pattern of change in prevalence, such as the lag time to a measurable impact and the duration of influence.     

Smoking Policy Change Within Permanent Supportive Housing

Smoke-free policies effectively reduce secondhand smoke (SHS) exposure among non-smokers, and reduce consumption, encourage quit attempts, and minimize relapse to smoking among smokers. Such policies are uncommon in permanent supportive housing (PSH) for formerly homeless individuals. In this study, we collaborated with a PSH provider in San Diego, California to assess a smoke-free policy that restricted indoor smoking. Between August and November 2015, residents completed a pre-policy questionnaire on attitudes toward smoke-free policies and exposure to secondhand smoke, and then 7–9 months after policy implementation residents were re-surveyed. At follow-up, there was a 59.7% reduction in indoor smoking. The proportion of residents who identified as current smokers reduced by 13% (95% CI: ?38, 10.2). The proportion of residents who reported never smelling SHS indoors (apartment 24.2%, 95% CI: 4.2, 44.1; shared areas 17.2%, 95% CI: 1.7, 32.7); in outdoor areas next to the living unit (porches or patio 56.7%, 95% CI: 40.7, 72.8); and in other outdoor areas (parking lot 28.6%, 95% CI: 8.3, 48.9) was lower post-policy compared with pre-policy. Overall, resident support increased by 18.7%; however, the greatest increase in support occurred among current smokers (from 14.8 to 37.5%). Fewer current smokers reported that the policy would enable cessation at post-policy compared to pre-policy. Our findings demonstrate the feasibility of implementing smoke-free policies in PSH for formerly homeless adults. However, policy alone appears insufficient to trigger change in smoking behavior, highlighting the need for additional cessation resources to facilitate quitting.     

Establishment and evaluation of a smoking cessation clinic in Hong Kong: a model for the future service provider

BACKGROUND: In the West, the effectiveness of smoking cessation programmes is well established. Smoking cessation programmes in the East are rare. We evaluated a pilot smoking cessation health centre (SCHC) of the Hong Kong Council on Smoking and Health (COSH). METHODS: The clinic operated 3 days a week from 6 to 9 pm. Smokers were recruited mainly by low cost publicity. Trained counsellors provided individual counselling and a 1 week free supply of nicotine replacement therapy (NRT). The programme was evaluated in terms of process, outcome and cost. RESULTS: During August 2000 to January 2002, 2212 calls were received through the clinic hotline and 1203 smokers attended the clinic. Eight hundred and forty-one were successfully followed up at 12 months. Based on intention-to-treat analysis, the 7 day point prevalence quit rate at 12 months (not smoking any cigarette during the past 7 days at the 12 month follow-up) was 27 per cent (95 per cent confidence interval, CI 25-30 per cent). The average cost per quitter was USD 339 (USD 440 including NRT cost for a 1 week free supply). Other benefits included training of healthcare workers and medical students, organization of seminars, health talks and self-help groups, and promotion of research and training. CONCLUSION: This first evaluation of a clinic-based smoking cessation service in Asia showed that the service was acceptable to Chinese smokers. The quit rate in this pilot part-time clinic is comparable to those of full-time and better funded clinics in the West. A part-time smoking cessation clinic is a promising model for piloting smoking cessation services in the East.     

上海市顾客选择无烟餐厅的影响因素调查

目的了解上海市顾客选择不同控烟制度的餐厅的影响因素及无烟政策对降低餐厅环境烟雾浓度的效果和对餐厅经营的影响。方法对上海市某中餐厅的顾客、空气质量、消费水平进行全面的调查。结果多因素研究结果表明,女性、不吸烟者、赞成无烟立法、以往就餐经历中"由于香烟烟雾而另选餐厅"的顾客更愿意选择餐厅无烟区,其OR(95%CI)分别为2.48(1.36～4.51)、2.01(1.06～3.79)、1.93(1.09～3.43)和5.65(3.11～10.29)。表示"实施无烟政策后更愿意来餐厅就餐"的顾客比例远高于"不愿意来"的顾客比例(38.8%比8.6%)。餐厅吸烟区细颗粒物浓度(PM2.5)明显高于无烟区。无烟区顾客消费情况与吸烟区消费情况差异无统计学意义。结论顾客的性别、目前吸烟情况、对无烟餐厅立法的态度、以往就餐时被动吸烟的经历,影响着顾客对不同控烟制度的餐厅的选择。无烟餐厅政策能增进顾客的就餐意愿,并且不会对餐厅经营带来负面影响,餐厅实施全面禁烟政策必要且可行。     

Impacts of a smoking cessation benefit among employed populations

OBJECTIVE: The objective of this study was to project the health and economic impacts of providing a workplace smoking cessation benefit. METHODS: The authors conducted an update of a previously published outcomes model using recently published data and clinical trial results. RESULTS: In four example workplace types evaluated, coverage of a cessation benefit resulted in greater numbers of successful cessations and decreased rates of smoking-related diseases. Total savings from benefit coverage (decreased healthcare and workplace costs) exceeded costs of the benefit within 4 years. Total savings per smoker ranged from 350 dollars to 582 dollars at 10 years and 1152 dollars to 1743 dollars at 20 years. Internal rate of return ranged from 39% to 60% at 10 years. CONCLUSION: Providing a workplace smoking cessation benefit results in substantial health and economic benefits with economic savings exceeding the cost of the benefit within a relatively short period. CLINICAL SIGNIFICANCE: Providing a workplace smoking cessation benefit is projected to increase the rate of smoking cessation as well as decrease the incidence of smoking-related conditions and healthcare costs. In addition, workplace cessation benefits can result in decreased absenteeism, increased productivity, and net cost savings within 4 years.     

Determining the cost-effectiveness of a computer-based smoking cessation intervention in primary care

PURPOSE: To evaluate the incremental effectiveness and cost-effectiveness of a staged-based, computerized smoking cessation intervention relative to standard care in an urban managed care network of primary care physicians. DESIGN: Decision-analytic model based on results of a randomized clinical trial. METHODOLOGY: Patient outcomes and cost estimates were derived from clinical trial data. Effectiveness was measured in terms of 7-day point-prevalence abstinence at 6 months post-intervention. Quality-adjusted life years (QALYs) and cost-effectiveness (CE) were calculated, with CE measured as cost per patient per life year saved and per quality-adjusted life years saved. CE estimates were adjusted to account for partial behavior change as measured in terms of progression in stage of readiness to quit. Sensitivity analyses were conducted to evaluate the robustness of key model assumptions. PRINCIPAL FINDINGS: Intervention patients were 1.77 times more likely to be smoke-free at 6 months follow-up than those in standard care (p=.078). The intervention generated an additional 3.24 quitters per year. Annualized incremental costs were $5,570 per primary care practice, and $40.83 per smoker. The mean incremental cost-effectiveness ratio was $1,174 per life year saved ($869 per QALY). When the intervention impact on progression in stage of readiness to quit was also considered, the mean incremental cost-effectiveness ratio declined to $999 per life year saved ($739 per QALY). CONCLUSIONS: From a physician's practice perspective, the stage-based computer tailored intervention was cost-effective relative to standard care. Incorporation of partial behavior change into the model further enhanced favorability of the cost-effectiveness ratio.     

Evaluation of the 1990 Centers for Disease Control and Prevention smoke-free policy

PURPOSE. To determine the prevalence of tobacco use among Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) employees and the effect of the smoke-free policy on smoking behavior and air quality at work. DESIGN. A stratified telephone survey of 1181 CDC/ATSDR employees randomly selected from employee rosters. SETTING. CDC/ATSDR work sites in Atlanta, Georgia, and other major CDC locations throughout the United States and Puerto Rico. SUBJECTS. Randomly selected employees of CDC/ATSDR1, or about 22% of the total CDC/ATSDR population; 98% of eligible persons selected agreed to participate. MEASURES. Demographic and smoking history variables, attitudes toward and impact of the smoke-free policy on smoking behavior, and self-report changes in air quality were the measures used. RESULTS. Overall cigarette smoking prevalence was only 11.1%. One percent reported using chewing tobacco, 1.1% reported smoking a pipe, and 1.4% reported smoking cigars. Average self-reported, daily cigarette consumption significantly decreased after the smoking ban took effect. Overall, 90% of the employees supported the smoke-free policy, and 80% of the employees believed that smokers were complying with the smoke-free policy. Most employees believed that the air quality of work areas and nonwork areas (65% and 69%, respectively) had improved since the smoke-free policy was implemented. CONCLUSIONS. These findings are consistent with previous evaluations of smoke-free policies and suggest that most employees are generally supportive of workplace smoking restrictions. Such policies can also have a positive impact on smoking behavior and perceived air quality.     

Are Tobacco Control Policies Effective in Reducing Young Adult Smoking?

PurposeWe examined the influence of tobacco control program funding, smoke-free air laws, and cigarette prices on young adult smoking outcomes.MethodsWe use a natural experimental design approach that uses the variation in tobacco control policies across states and over time to understand their influence on tobacco outcomes. We combine individual outcome data with annual state-level policy data to conduct multivariable logistic regression models, controlling for an extensive set of sociodemographic factors. The participants are 18- to 25-year-olds from the 2002–2009 National Surveys on Drug Use and Health. The three main outcomes are past-year smoking initiation, and current and established smoking. A current smoker was one who had smoked on at least 1 day in the past 30 days. An established smoker was one who had smoked 1 or more cigarettes in the past 30 days and smoked at least 100 cigarettes in his or her lifetime.ResultsHigher levels of tobacco control program funding and greater smoke-free-air law coverage were both associated with declines in current and established smoking (p < .01). Greater coverage of smoke-free air laws was associated with lower past year initiation with marginal significance (p = .058). Higher cigarette prices were not associated with smoking outcomes. Had smoke-free-air law coverage and cumulative tobacco control funding remained at 2002 levels, current and established smoking would have been 5%–7% higher in 2009.ConclusionsSmoke-free air laws and state tobacco control programs are effective strategies for curbing young adult smoking.     

A model for cost-effectiveness analyses of smoking cessation interventions applied to a Quit-and-Win contest for mothers of small children

AIMS: The first aim of this study was to develop a model that predicts health and economic consequences of smoking cessation in Sweden, striving to follow the methodological recommendations to reflect the societal perspective and to use the health measure quality-adjusted life-years (QALYs). The second aim was to apply the model estimates to a smoking cessation intervention. METHODS: A Markov cost-effectiveness model was developed on smoking-related lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease. Swedish primary data on medical treatment costs and quality-of-life weights were used, supplemented with secondary data on other societal effects and the disease and death risks. The model simulations were applied to a "Quit-and-Win" contest for mothers of pre-school children. In total, 238 women participated, with 34 sustained tobacco-free at 12-month follow-up. RESULTS: The cost-effectiveness model estimates a gain of 0.34 to 0.55 QALYs (discounted 3%), and cost savings of SEK 20-35,000 per female quitter in the age range 15 to 49 years. The cost-effectiveness analyses of the intervention showed intervention costs per quitter of SEK 7,850, and intervention costs per life-years saved (YLS) (discounted 3%) of SEK 13,200. The cost-utility analysis demonstrated cost savings and a gain of 16 QALYs. CONCLUSIONS: The cost-utility analysis estimated health gains and cost savings resulting from the "Quit-and-Win" contest. As the model estimates on the differences in societal cost between smokers and quitters are considerable, many tobacco control programmes would result in cost savings. The construction of an optimal mix of tobacco control policies, however, demands incremental calculations on a range of programmes.