To allow us to understand what makes tobacco control more successful at a given level of tobacco burden in a country, we will estimate the burden of tobacco and then carry out comparative return on investment analyses based on three key indicators over different payback timescales (2, 5, 10 years and lifetime): Net Present Value (NPV) Savings; Cost per QALY and; Benefit-Cost ratios. To ensure cross-country comparability a package of interventions for inclusion will be agreed in the stakeholder consensus workshops.
We will produce a long list of ROI model components which are similar across sample countries (core components) and those which vary between countries (country-specific components). We will assess which of the country-specific components cause the highest variability in ROI model results across the sample countries and use this to create a short list of key variability factors.
We will test whether these key variability factors would provide similar policy recommendations if the data was collected for out-of-sample countries and then used in the ROI model. To do this, we will collect data on the short list of key variables in a limited number of out-of-sample EU countries (n=3). A less time- and resource-intensive data collection process is deemed appropriate at this stage because the aim is to test the above assumption around transferability to only 3 countries.
The 3 countries chosen will be systematically different from the four sample countries & UK – lower-income with less availability of HTA decision support mechanisms and much higher smoking prevalences i.e. a higher potential to save life years. Country-specific data will be collected, and used to create a local ROI v2.0 model for each country. The policy recommendations for these non-sample countries will be compared with those from sample countries to assess potential improvements to the transferability of the ROI evidence to other EU countries.
The country-specific ROI v2.0 models will be reprogrammed into a single, web-based tool. This tool will be validated and exact technical and security requirements established. The web tool will be accessible via the EQUIPT website and hosted on the servers of one or more consortium partners. The outcome will be a fully-validated web tool which can be used as part of dissemination procedures and will ultimately become the final deliverable product of this project.