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Economic Burden of Smoking-Attributable Diseases in West Africa, 2012

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Economic Burden of Smoking-Attributable Diseases in West Africa, 2012 Economic Burden of Smoking-Attributable Diseases in West Africa, 2012 Nerisa – Hope Neg Tetang Cancer Control and Population Health National Cancer Center Graduate School of Cancer Science and Policy July 2019 Economic Burden of Smoking-Attributable Diseases in West Africa, 2012 A Thesis Submitted to the Department of Cancer Control and Population Health in Partial Fulfillment of the Requirements for the Master’s Degree of Public Health Nerisa-Hope Neg Tetang July 2019 National Cancer Center Graduate School of Cancer Science and Policy Professor Jin Kyoung Oh We hereby approve the M.S. thesis of Nerisa - Hope Neg Tetang. July 2019 sign Chairman of Thesis Committee Thesis Committee Member sign Thesis Committee Member NATIONAL CANCER CENTER GRADUATE SCHOOL OF CANCER SCIENCE AND POLICY ABSTRACT Economic Burden of Smoking-Attributable Diseases in West Africa, 2012 Background: Smoking is a major public health threat for a variety of diseases. Developing countries are at a high risk of epidemic increases from smoking-associated illnesses since smoking prevalence in these countries has been increasing over the years, with no major policies being put forth to combat this. To date, no studies have examined the economic burden in monetary terms in West Africa. Therefore, information on the economic costs of smoking-related diseases is required to view the extent of the tobacco epidemic on society. Methods: The economic burden of smoking-attributable diseases as defined using the ICD-10 (International Classification of Disease) codes in 2012 is estimated using the SAMMEC approach to measure the disease burden in terms of mortality and morbidity and the Cost of Illness approach to measure costs. The study includes direct costs and indirect costs where direct cost represents smoking-attributable healthcare expenditure, and indirect costs, which are estimated by identifying the productivity loss from morbidity and future income loss due to premature death. Our study included 12 West iv African countries (for which all required data was available) within the age group 15–59years (because of the time lag for developing non-communicable diseases and the average life expectancy in West Africa). We calculate the Population attributable fraction for each disease using smoking prevalence by country and gender, which was used in computing values to calculate labour loss to morbidity and mortality. All necessary data was obtained from various international open sources, including the international monetary fund database, World Health Organization (WHO), and World Bank reports. The analysis was done using Excel 2013. Results: There were about 42,033 deaths attributable to smoking in West Africa in 2012, accounting for 37% of all deaths from smoking-associated disease included in this study. Mortality rates were almost 10 times higher in men than in women. The overall cost of healthcare expenditure on smoking-attributable diseases stood at approximately PPP$784 million proportionate to 1.7% of the region‟s total health expenditure. The total economic costs of smoking (from healthcare expenditure and both productivity losses) estimated totaled PPP$ 3,158 million, which accounts for 0.3% of the region‟s annual gross domestic product (GDP) for 2012. Compared to low-and-middle-income countries, the disease burden is slightly higher in low-income countries. Furthermore, looking at the country-specific situations; Sierra Leone had a far greater economic burden v than other countries with total cost amounting to 1.1% of its country‟s national GDP. Conclusions: Effective tobacco control measures such as preventive programs must be implemented in West African countries to reduce the burden of smoking-attributable diseases. The need for these urgent control policies is particularly required in Sierra Leone and Cote d‟Ivoire, where the tobacco epidemic is most advanced. vi Copyright by Nerisa-Hope Neg Tetang 2019 vii Contents 1. Introduction ............................................................................................ 1 1.1 Background ........................................................................................ 1 1.1.1 Tobacco use and burden of smoking in the world..................... 3 1.1.2 Tobacco use and burden of smoking in West Africa ................ 5 1.2 Study Purpose ..................................................................................... 8 1.3 Tobacco and related diseases ........................................................... 10 1.4 Disease burden and cost of illness .................................................... 12 2. Methods and Materials ........................................................................ 19 2.1 Definition of Smoking related diseases ............................................ 19 2.2 Target Population / Countries .......................................................... 19 2.3 Definition of Costs ........................................................................... 20 2.4 Estimation of Economic burden of smoking-related diseases .......... 21 2.4.1 Estimating the Physical burden of smoking-related ................ 21 2.4.2 Estimating Direct Costs ........................................................... 24 2.4.3 Estimating Indirect Costs ........................................................ 26 2.4.4 Sensitivity analysis by discount rates ...................................... 28 viii 3. Results ................................................................................................... 30 3.1 Burden of disease ............................................................................. 30 3.2 Direct Costs ...................................................................................... 35 3.3 Indirect Costs .................................................................................... 37 3.4 Overall Costs .................................................................................... 39 3.5 Sensitivity analysis ........................................................................... 41 3.6 Figure Explanation ........................................................................... 43 4. Discussions ............................................................................................ 49 4.1 Overall results .................................................................................. 59 4.2 Further evaluation and comparison between countries .................... 52 4.3 Limitation and Strengths .................................................................. 59 5. Conclusions ........................................................................................... 61 Appendices ............................................................................................. 63 Bibliography ........................................................................................... 74 ix List of Tables Table 1. Relative risk of death for smokers and ex-smokers comparing to nonsmokers .................................................................................. 24 Table 2. Costs and variable type, description and sources of data ............ 29 Table 3. Smoking-attributable mortality applying PAF for males aged 15 – 59years by disease and country in West Africa, 2012 ................. 31 Table 4. Smoking-attributable mortality applying PAF for females aged 15-59 by disease and country in West Africa, 2012 .................... 32 Table 5. Smoking-attributable burden of disease and loss of labour force for age group 15-59, by country ........................................................ 34 Table 6. Direct cost (smoking-attributable health expenditure) of smoking-related diseases in West Africa, 2012 ........................... 36 Table 7. Cost of productivity loss due to morbidity, future income loss due to premature death and total indirect cost from smoking-attributable diseases by country in West Africa.............................................. 38 Table 8. Overall costs of smoking-attributable diseases by country in West Africa ........................................................................................... 40 Table 9. Sensitivity analysis of Economic cost by discount rates ............. 42 Table 10. The extent of tobacco control measures implemented in West African Countries ......................................................................... 58 x List of Figures Figure 1. Smoking-attributable mortality rate by gender in West African countries, 2012 ............................................................................. 44 Figure 2. Proportion of deaths caused by smoking-related diseases in West Africa, 2012 ................................................................................. 44 Figure 3. Total observed mortality rate and total smoking-attributable mortality rate for age group 15-59years in West African Countries, 2012 ........... 45 Figure 4. Proportion of cost component (%) ............................................. 46 Figure 5. Proportion of direct and indirect cost by country ....................... 47 Figure 6. Relative comparison of costs related tobacco use between West Africa, and other westernized and world‟s average ..................... 48 xi 1. Introduction 1.1 Background Health is an important component of economic growth. The return to capital investment for economic growth and development is greatly influenced by health capital because healthier workers tend to be mentally and physically more energetic. Hence, any nation experiencing a heavy burden of disease
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