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Implementation of a national smoke-free prison policy: an economic evaluation within the Tobacco in Prisons (TIPs)
Nicola McMeekin1, Olivia Wu2, Kathleen Anne Boyd2
1HEHTA, Institute of Health and Wellbeing, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK nicola.mcmeekin@glasgow.ac.uk.
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.
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