Costs, health effects and cost-effectiveness of alcohol and tobacco control strategies in Estonia

ObjectiveTo assess the population-level costs, effects and cost-effectiveness of different alcohol and tobacco control strategies in Estonia.DesignA WHO cost-effectiveness modelling framework was used to estimate the total costs and effects of interventions. Costs were assessed in Estonian Kroon (EEK) for the year 2000, while effects were expressed in disability-adjusted life years (DALYs) averted. Regional cost-effectiveness estimates for Eastern Europe, were used as baseline and were contextualised by including country-specific input data.ResultsIncreased excise taxes are the most cost-effective intervention to reduce both hazardous alcohol consumption and smoking: 759 EEK (€49) and 218 EEK (€14) per DALY averted, respectively. Imposing additional advertising bans would cost 1331 EEK (€85) per DALY averted to reduce hazardous alcohol consumption and 304 EEK (€19) to reduce smoking. Compared to WHO-CHOICE regional estimates, interventions were less costly and thereby more cost-effective in Estonia.ConclusionsInterventions in alcohol and tobacco control are cost-effective, and broad implementation of these interventions to upgrade current situation is warranted from the economic point of view. First priority is an increase in taxation, followed by advertising bans and other interventions. The differences between WHO-CHOICE regional cost-effectiveness estimates and contextualised results underline the importance of the country level analysis.