Implementation of a national smoke-free prison policy: an economic evaluation within the Tobacco in Prisons (TIPs) study

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
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 Leyland, Professor Alastair and Boyd, Professor Kathleen and Wu, Professor Olivia 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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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
304677Evaluating graduated progress towards and impacts of the implementation of indoor smoke free prison facilities in Scotland (TIPS)Helen SweetingNational Institute for Health Research (NIHR)05571_NIHR 15/55/44_TIPSSHW - MRC/CSO Social & Public Health Sciences Unit
168560MRC SPHSU/GU Transfer FellowshipsLaurence MooreMedical Research Council (MRC)MC_PC_13027SHW - MRC/CSO Social & Public Health Sciences Unit
301147Morbidity and mortality among people experiencing severe and multiple disadvantage: a cohort study using cross-sectoral data linkageEmily TweedOffice of the Chief Scientific Adviser (CSO)CAF/17/11SHW - MRC/CSO Social & Public Health Sciences Unit
727651Measuring and Analysing Socioeconomic Inequalities in HealthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU13HW - MRC/CSO Social and Public Health Sciences Unit
727671Informing Healthy Public PolicyPeter CraigOffice of the Chief Scientific Adviser (CSO)SPHSU15HW - MRC/CSO Social and Public Health Sciences Unit
727651Measuring and Analysing Socioeconomic Inequalities in HealthAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13HW - MRC/CSO Social and Public Health Sciences Unit
727671Informing Healthy Public PolicyPeter CraigMedical Research Council (MRC)MC_UU_12017/15HW - MRC/CSO Social and Public Health Sciences Unit
3048230021Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit