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BMC Medicine
Published in: BMC Medicine 1/2019

Open Access 01-12-2019 | Tuberculosis | Research article

The potential impact and cost-effectiveness of tobacco reduction strategies for tuberculosis prevention in Canadian Inuit communities

Authors: Dieynaba S. N’Diaye, Ntwali Placide Nsengiyumva, Aashna Uppal, Olivia Oxlade, Gonzalo G. Alvarez, Kevin Schwartzman

Published in: BMC Medicine | Issue 1/2019

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Abstract

Background

Tuberculosis (TB) remains a significant public health problem in Canadian Inuit communities. In 2016, Canadian Inuit had an incidence rate 35 times the Canadian average. Tobacco use is an important risk factor for TB, and over 60% of Inuit adults smoke. We aimed to estimate changes in TB-related outcomes and costs from reducing tobacco use in Inuit communities.

Methods

Using a transmission model to estimate the initial prevalence of latent TB infection (LTBI), followed by decision analysis modelling, we conducted a cost-effectiveness analysis that compared the current standard of care for management of TB and LTBI without additional tobacco reduction intervention (Status Quo) with (1) increased tobacco taxation, (2) pharmacotherapy and counselling for smoking cessation, (3) pharmacotherapy, counselling plus mass media campaign, and (4) the combination of all these. Projected outcomes included the following: TB cases, TB-related deaths, quality-adjusted life years (QALYs), and health system costs, all over 20 years.

Results

The combined strategy was projected to reduce active TB cases by 6.1% (95% uncertainty range 4.9–7.0%) and TB deaths by 10.4% (9.5–11.4%) over 20 years, relative to the status quo. Increased taxation was the only cost-saving strategy.

Conclusions

Currently available strategies to reduce commercial tobacco use will likely have a modest impact on TB-related outcomes in the medium term, but some may be cost saving.
Appendix
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Metadata
Title
The potential impact and cost-effectiveness of tobacco reduction strategies for tuberculosis prevention in Canadian Inuit communities
Authors
Dieynaba S. N’Diaye
Ntwali Placide Nsengiyumva
Aashna Uppal
Olivia Oxlade
Gonzalo G. Alvarez
Kevin Schwartzman
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2019
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-019-1261-5

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