Cost of youth tobacco-control policies in seven European countries

Background: Tobacco-control policies have been suggested to reduce smoking among adolescents. However, there is limited evidence on the real-world costs of implementation in different settings. In this study, we aimed at estimating the costs of school smoking bans, school prevention programmes and non-school bans (smoking bans in non-educational public settings, bans on sales to minors and bans on point-of-sale advertising), implemented in Finland, Ireland, the Netherlands, Belgium, Germany, Italy and Portugal, for 2016. Methods: We retrospectively collected costs related to the inspection, monitoring and sanctioning activities related to bans and educational activities related to smoking prevention programmes. We used an ‘ingredients-based’ approach, identifying each resource used, quantity and unit value for one full year, under the state perspective. Costs were measured at national, regional, local and school-level and were informed by data on how these activities were performed in reality. Results: Purchasing power parities adjusted-costs varied between E0.02 and E0.74 (average E0.24) per person (pp) for bans implemented outside schools. Mean costs of school smoking bans ranged from E3.31 to E34.76 (average E20.60), and mean costs of school educational programmes from E0.75 to E4.65 (average E2.92). Conclusions: It is feasible to estimate costs of health policies as implemented in different settings. Costs of the tobacco control policies evaluated here depend mainly on the number of person-hours allocated to their implementation, and on the scale of intervention. Non-school bans presented the lowest costs, and the implementation of all policies cost up to E36 pp for 1 year.