Implementation of a national smoke-free prison policy: an economic evaluation within the Tobacco in Prisons (TIPs) study

Nicola McMeekin; Olivia Wu; Kathleen Anne Boyd; Ashley Brown; Emily J Tweed; Catherine Best; Peter Craig; Alastair H Leyland; Evangelia Demou; Tom Byrne; Jill Pell; Sean Semple; Helen Sweeting; Lesley Graham; Kate Hunt

doi:10.1136/tobaccocontrol-2021-056991

Implementation of a national smoke-free prison policy: an economic evaluation within the Tobacco in Prisons (TIPs) study

Tob Control. 2023 Nov;32(6):701-708. doi: 10.1136/tobaccocontrol-2021-056991. Epub 2022 Mar 7.

Authors

Affiliations

¹ HEHTA, Institute of Health and Wellbeing, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK nicola.mcmeekin@glasgow.ac.uk.
² HEHTA, Institute of Health and Wellbeing, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK.
³ Institute for Social Marketing and Health, University of Stirling, Stirling, UK.
⁴ MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
⁵ Healthcare Improvement Scotland, Glasgow, UK.
⁶ Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
⁷ Public Health Scotland, Edinburgh, UK.

Abstract

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.

Keywords: economics; public policy; secondhand smoke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Humans
Nicotiana
Prisons
Quality of Life
Smoke-Free Policy*
Tobacco Smoke Pollution* / analysis
Tobacco Smoke Pollution* / prevention & control

Substances

Tobacco Smoke Pollution

Abstract

Publication types

MeSH terms

Substances

Grants and funding