Research Article |
Corresponding author: Saba Madae’en ( saba@hu.edu.jo ) Academic editor: Valentina Petkova
© 2022 Saba Madae’en, Rasha Istaiteyeh, Mohammad Adeinat, Nour Obeidat, Rasha A. Baninasur, Mansour Haddad.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Madae’en S, Istaiteyeh R, Adeinat M, Obeidat N, Baninasur RA, Haddad M (2022) Smoking cessation economic benefits in a human capital approach: emerging evidence in Jordan. Pharmacia 69(4): 1081-1087. https://doi.org/10.3897/pharmacia.69.e96801
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Background: Smoking is a major cause globally of morbidity and mortality hence life years lost, this issue manifested in 399 Million Jordanian dinars (JD)($562.3 million USD) lost yearly due to productivity lost as a consequence of smoking in Jordan
Methodology: We present a transparent, generic model based on accepted analytic methods that allow users to assess the present value of lifetime earnings gained (PVLE) in smokers who intend to quit. It is shown in previous studies that smoking cessation aids are cost-effective in Jordan (
Results: We found productivity loss was reduced in males who attempted to quit in their productive years. Using Varenicline, the researchers calculated the expected future payments (wages) count for years gained due to varenicline use for a wage average of 507 JDs ($714.5 USD) per month discounted by 8% for the rest of their productive life. As well as for the other two scenarios, the gained productivity from one course of varenicline to the male adults over 30 who intend to quit will reduce loss by more than 72 billion JDs ($101.42 billion USD) among the working-age population followed up until retirement.
Conclusion: policy change must be approached to reimbursement of smoking cessation aid in the Jordanian formulary.
smoking cessation, Pharmacoeconomics, economic benefit
The indirect cost of tobacco pandemic in the year 2022 was 399 Million Jordanian dinars ($562.3 million USD)/ year (JSF 2022).
Jordan has shown to be one of the highest prevalence of smoking worldwide counting up to 70% in the middle age male population, according to the Tobacco Atlas
There are two different kinds of productivity losses. The first is potential years of potential life lost (YPLL) caused by pre-mature deaths in the population that can be linked to smoking. The second is lost workday productivity, which is time lost on the job due to smoking cigarettes. In the current study, we only did the loss due to years of potential life lost (YPLL) (
We are not the first to study the effect of smoking cessation aids benefit in reducing productivity loss. Notably, a study conducted in the USA studied the indirect cost of smoking as well as the benefit of smoking cessation aids, it revealed work productivity losses of approximately USD $ 67.5 billion, premature death losses of USD $117 billion, while smoking cessation aids use revealed substantial benefits on the indirect costs (
As for the effect of quitting smoking on productivity loss a systematic review and meta-analysis of 29 longitudinal and cohort studies of working adults found that the increased risk of absenteeism was 33% higher for current smokers than non-smokers and 19% higher than for former smokers. Current smokers took an average of 2–3 days more absenteeism per year than non-smokers (
Attempts to measure smoking cessation on lifetime direct costs and consequences of smokers who make a one-time attempt to quit smoking were in
In
In
In our study we will focus on the lost productivity due to lost life years and compare it to productivity increased in smokers due to the use of smoking cessation aids in Jordanian male smokers who intend to quit. Many studies have shown that smokers have higher productivity loss than former smokers.
A previous study demonstrated through a cost-effectiveness study the benefit of offering smoking cessation aids to male smokers who intend to quit in Jordan for one course and the gained life years for the smokers who intended to quit population (
There is a consensus that researchers should work on health economics analysis from a societal perspective as much as possible as this is the most comprehensive. Moreover, the cost of productivity lost is to be taken into account for true societal analysis. For example, an illness can affect society not only through financial transactions related to the exchange of goods and services to treat the illness but also by losing an individual’s contribution to society throughout life due to the illness or premature death.
The Markov model was conducted for a population of 8 age groups (30–34, 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, and 65–70) under three scenarios:
The results of the Markov model are presented in Table
Present value for lifetime earnings for each age group under the three scenarios.
Number of smokers | PVLE | Life-years/Person | |
---|---|---|---|
Age 30–34 | 123.476 | ||
Varenicline | 63097.52 | 23.00 | |
NRT | 63004.26 | 22.91 | |
Placebo | 62858.09 | 22.76 | |
Age 35–39 | 109.453 | ||
Varenicline | 57728.5 | 18.49 | |
NRT | 57567.8 | 18.39 | |
Placebo | 57421.42 | 18.28 | |
Age 40–44 | 95.062 | ||
Varenicline | 50316.9 | 14.08 | |
NRT | 50157.9 | 13.99 | |
Placebo | 49837.14 | 13.85 | |
Age 45–49 | 80.768 | ||
Varenicline | 41776.2 | 10.36 | |
NRT | 41528.7 | 10.27 | |
Placebo | 41282.01 | 10.17 | |
Age 50–54 | 59.340 | ||
Varenicline | 31845.8 | 7.05 | |
NRT | 31675.56 | 6.99 | |
Placebo | 31370.57 | 6.91 | |
Age 55–59 | 40.366 | ||
Varenicline | 22919.4 | 4.66 | |
NRT | 22676.8 | 4.61 | |
Placebo | 22647.73 | 4.56 | |
Age 60–64 | 10.883 | ||
Varenicline | 15586.1 | 2.99 | |
NRT | 15469.5 | 2.96 | |
Placebo | 15352.95 | 2.93 | |
Age 65–70 | 7.770 | ||
Varenicline | 9357.3 | 1.71 | |
NRT | 9232.4 | 1.69 | |
Placebo | 9228.86 | 1.68 |
For each age group, present values for lifetime earnings are different for the three scenarios (Varenicline, NRT, and Placebo). Notice that within each age group, the present value for lifetime earnings seemed to be highest for Varenicline, in comparison to the other two scenarios (NRT and Placebo). Presents on value for lifetime earnings decreased as age increased. Under the scenario Varenicline, the population of age 30–34 had the highest present value for lifetime earnings gained (PVLE = 63097.52) due to longer life expectancy and benefit from smoking cessation at a younger age, and the population of age 65–70 had the lowest present value for lifetime earnings gained (PVLE = 9657.3) (Table
Using this data, we will analyze the productivity lost. An analysis was conducted to determine the present value for lifetime earnings (PVLE) of future payment using the human capital approach. In particular, the formula used to compute PVLE was:
Note that j represents gender, j = 1 for male and j = 2 for female; i represents age. Additionally,
To our knowledge, there are no existing models that provide estimates of productivity costs for such a wide array of countries or that utilize a methodology that can be modified to estimate productivity costs of specific subgroups of interest (
We present a transparent, generic model based on accepted analytic methods that allow users to assess the present value of lifetime earnings (PVLE) for Jordan. Our model incorporates mortality rates from the Markov Model in order to estimate smoking-related lost productivity costs. In
We found productivity gains in males who attempted to quit in their productive years. Further, for a treatment cohort of 527,118 Jordanian male smokers who intended to quit with varenicline, the total life-years gained by males was calculated as 103970 years by the average wage of 507 JDs ($714.5 USD) per month for the year 2016. we used our reference year 2016 because the Markov model used data of 2016 making it more accurate, we used average wage from the same year as well as the unemployment percentage for males in the same period. We add a discount rate of 8% because the future payment discount rate for developing countries is higher than in developed countries (Valentin, et al. 2010), hence, the discount rate considers the market risk premium and the tax rate. For the NRT are 64,030 life years were gained using the NRT regimen (compared to the no-intervention and same variables and methodology as varenicline was used to calculate present value of lost earning.
The results of the Markov model are presented in Table
For each age group, Notice that within each age group, life years expected for every smoker seemed to be highest for Varenicline, in comparisons to the other two scenarios (NRT and Placebo). Present value for lifetime earnings decreased as age increased .Under the scenario Varenicline, the population of age 30–34 had the longest life years expected for every smoker (Life-years/Person = 23.00) and the population of age 65–70 had the shortest life years expected for every smoker (Life-years/Person = 1.71) (Table
From the group using Varenicline the expected future payments (wages) count for productive years for a wage average of 507 JDs ($714.5 USD) per month discounted by 8% for the rest of their productive life. While for the same group were offered only physician counselling, the total 103,970 productive years will be lost, and we used the same average wage and discount rate. The gained productivity from one course of varenicline was 72760406228 JDs,($102538475601 USD) compared to physician counseling only. Nearly a 73 billion Jordanian dinars ($102 billion USD) for the productive lifetime of smokers intended to quit who are offered a course of varenicline.In sensitivity analysis the results were shown to be significant on a wide range of life years gained per age group.
Additional costs to employers include lost productivity resulting from illness and smoking breaks, increased accidents and workers’ compensation costs, early retirement for disability, increased facility costs for ventilation systems. Most importantly is the healthcare costs for diseases caused by smoking, such as cardiovascular disease, stroke, chronic obstructive lung disease, and preterm birth, but we couldn’t do this now for the lack of data in the Jordanian population, but it is a near-future plan.
Our results are much similar to studies conducted in other countries where the benefits of quitting smoking on work productivity were comparable to the United State, European Union Five (France, Germany, Italy, Spain, United Kingdom), and China. The results suggest that quitting benefits extend to work productivity rapidly after cessation, serving to further encourage and promote the implementation of workplace cessation programs (
Other studies in third world countries such as Indonesia estimated that smoking caused 846 123 excess deaths, 2.9 million years of life lost, 41.6 million Quality Adjusted Life Years (QALYs) lost and 15.6 million productivity adjusted life years (PALYs) lost. The total cost of productivity loss due to smoking amounted to USD $183.7 billion among the working-age population followed up until retirement (Satyana et al. 2020). In a research conducted in China, it was revealed that use of smoking cessation aids saves lives and consequently money and productivity, and the WHO in 2014 declared that productivity lost counted to USD $48 billion in china (
The benefit is studied worldwide as declared in a research paper done by
In another continent a study conducted in Mexico Assuming a 250 employees company and a shared proportion of 50% of the costs of the program between employees and employers, the simulation showed a rapid profit to the company in the first 3 years, companies would have to invest USD $178 per employee only at the first year, and have potential savings of USD $228 for each of them after 3 years. In the same circumstances, the net productivity gains per program participant would be in an amount of 70.8 hours (
Other relevant studies have showed a cost-saving effect of smoking cessation aids use in a systematic review of 15 articles on nicotine-based pharmacotherapies, 12 articles on non-nicotine-based pharmacotherapies, no articles on selegiline, and 10 articles on brief counselling for smoking cessation treatment. Results show that both pharmaco- and behavioral therapies for smoking cessation are cost-effective or even cost-saving (
On the contrary, other researchers extended their economic model to include aging and costs of medical care for the aging former smokers to conclude that short term economic benefits are not the whole picture. The effects of reduced smoking on overall health care costs i.e. accounting for the long term health care costs of an increase in the elderly population are by 2030, savings become negative in all countries apart from Romania, Switzerland, Portugal and Austria due to the cost of caring for a greater number of older people (