Background
Methods
Modelled intervention
Modelling approach
Intervention effect size
Intervention costs
Results
Demographic group | Non-Māori QALYs gained | Māori QALYs gained | Ethnic groupings combined, QALYs gained | Ethnic groupings combined, cost-savings (NZ$ million) |
---|---|---|---|---|
Sex and age groups combined | 4650 (3540 to 5910) | 2120 (1590 to 2720) | 6760 (5420 to 8420) | $115 (72.5 to 171) |
Males, 15–24 years | 379 (200 to 619) | 175 (92.6 to 292) | 554 (347 to 835) | $14.8 (7.43 to 25.9) |
Males, 25–44 years | 1220 (821 to 1690) | 390 (262 to 543) | 1610 (1170 to 2150) | $40.1 (25.1 to 58.9) |
Males, 45–64 years | 654 (422 to 954) | 142 (88.7 to 215) | 796 (548 to 1100) | $11.7 (5.47 to 19.8) |
Males, 65+ years | 39.3 (24.2 to 59.4) | 3.15 (1.77 to 4.84) | 42.5 (27.1 to 62.7) | $-2.12 (−1.81 to −2.37) |
Males, all ages | 2300 (1730 to 2980) | 710 (530 to 926) | 3010 (2370 to 3780) | $60.1 (36.9 to 89.7)a |
Females, 15–24 years | 407 (218 to 650) | 292 (155 to 479) | 700 (447 to 1020) | $13.8 (6.91 to 23.1) |
Females, 25–44 years | 1280 (865 to 1790) | 813 (548 to 1120) | 2090 (1550 to 2720) | $38.9 (24.9 to 57.6) |
Females, 45–64 years | 628 (397 to 910) | 295 (182 to 447) | 924 (660 to 1250) | $9.4 (3.96 to 16.4) |
Females, 65+ years | 39.4 (24.7 to 58.8) | 5.78 (3.34 to 8.80) | 45.2 (29.9 to 65.1) | $-2.71 (− 2.46 to − 2.94) |
Females, all ages | 2350 (1750 to 3050) | 1410 (1050 to 1830) | 3760 (2970 to 4690) | $55.1 (34.1 to 82.6)a |
Per capita (QALYs /1000 people & $)b | 1.25 (0.95 to 1.58) | 3.14 (2.36 to 4.03) | 1.54 (1.23 to 1.91) | $26.2 (16.5 to 38.9) |
Discussion
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The effect size was based on just a single RCT (with quitting measured at 6 months), albeit the RCT (out of the three published as of October 2018) to be considered the most relevant to the New Zealand population. However, we did a scenario analysis with half the effect size, which may better reflect the mixed outcome of these three trials.
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The baseline quit rate does not capture recent features of the tobacco control scene in New Zealand such as: the rise of e-cigarette use [27], the adoption of standardised tobacco packaging in New Zealand in 2018, and tobacco industry actions (eg, discount brands) that may undermine the ongoing annual tobacco tax increases used in New Zealand [28].
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No account was taken of potentially more efficient marketing strategies eg, via use of social media as per one study [29]. Similarly, no account was made of the potential synergies that could be achieved if app promotion was focused around the timing of World Smokefree Day activities or the annual rise in tobacco taxes in January of each year in New Zealand.
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The modelling only took a health system perspective. If a broader societal perspective was taken then the benefits would be higher since smoking is negatively related to long-term labour market outcomes [30].