McMeekin, N. et al. (2023) Implementation of a national smoke-free prison policy: an economic evaluation within the Tobacco in Prisons (TIPs) study. Tobacco Control, 32(6), pp. 701-708. (doi: 10.1136/tobaccocontrol-2021-056991) (PMID:35256533) (PMCID:PMC7615232)
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Abstract
Objective: To determine the cost-effectiveness of a smoke-free prison policy in Scotland, through assessments of the trade-offs between costs (healthcare and non-healthcare-related expenditure) and outcomes (health and non-health-related non-monetary consequences) of implementing the policy. Design: A health economic evaluation consisting of three analyses (cost-consequence, cost-effectiveness and cost-utility), from the perspectives of the healthcare payer, prison service, people in custody and operational staff, assessed the trade-offs between costs and outcomes. Costs associated with the implementation of the policy, healthcare resource use and personal spend on nicotine products were considered, alongside health and non-health outcomes. The cost-effectiveness of the policy was evaluated over 12-month and lifetime horizons (short term and long term). Setting: Scotland’s national prison estate. Participants: People in custody and operational prison staff. Intervention: Implementation of a comprehensive (indoor and outdoor) smoke-free policy. Main outcome measures: Concentration of secondhand smoke, health-related quality of life (health utilities and quality-adjusted life-years (QALY)) and various non-health outcomes (eg, incidents of assaults and fires). Results: The short-term analyses suggest cost savings for people in custody and staff, improvements in concentration of secondhand smoke, with no consistent direction of change across other outcomes. The long-term analysis demonstrated that implementing smoke-free policy was cost-effective over a lifetime for people in custody and staff, with approximate cost savings of £28 000 and £450, respectively, and improvement in health-related quality of life of 0.971 QALYs and 0.262, respectively. Conclusion: Implementing a smoke-free prison policy is cost-effective over the short term and long term for people in custody and staff.
| Item Type: | Articles |
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| Additional Information: | This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme (15/55/44). The data management and analysis of the prison canteen data was undertaken by CB, with support from AB and KH, through grant funding from Cancer Research UK (C45874/A27016). ED also acknowledges funding from the Medical Research Council partnership grant (MC_PC_13027). Some authors were also funded by the Chief Scientist Office: EJT (CAF/17/11), EJT and AHL (SPHSU13), EJT and PC (SPHSU15), and EJT, AHL, ED and PC (SPHSU17). Some authors were also funded by the Medical Research Council: EJT and AHL (MC_UU_12017/13), EJT and PC (MC_UU_12017/15), and EJT, AHL, ED and PC (MC_UU_00022/2). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Hunt, Professor Kathryn and Demou, Dr Evangelia and Brown, Ms Ashley and Mcmeekin, Dr Nicola and Craig, Professor Peter and Pell, Professor Jill and Wu, Professor Olivia and Boyd, Professor Kathleen and Leyland, Professor Alastair and Tweed, Dr Emily and Sweeting, Dr Helen |
| Authors: | McMeekin, N., Wu, O., Boyd, K., Brown, A., Tweed, E. J., Best, C., Craig, P., Leyland, A. H., Demou, E., Byrne, T., Pell, J., Semple, S., Sweeting, H., Graham, L., and Hunt, K. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU |
| Journal Name: | Tobacco Control |
| Publisher: | BMJ Publishing Group |
| ISSN: | 0964-4563 |
| ISSN (Online): | 1468-3318 |
| Published Online: | 07 March 2022 |
| Copyright Holders: | Copyright © 2022 The Authors |
| First Published: | First published in Tobacco Control 32(6):701-708 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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