{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T18:03:57Z","timestamp":1771956237366,"version":"3.50.1"},"reference-count":58,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,4]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study conducts a cost-effectiveness analysis of the Tobacco Treatment Programme (TTP) of Uruguay\u2019s National Resource Fund (NRF), within the context of the country\u2019s advanced implementation of tobacco control policies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We run a 10\u2009000 Markov model simulation with three states (people who smoke, people who have quit smoking and death) to simulate the trajectories of a cohort. The model has been widely used in previous studies evaluating smoking cessation interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>For the simulations, we use information from the 2016 to 2017 NRF TTP cohort. Nearly half of the participants lived in the capital, one-fifth had tertiary education, and about one-third had public health coverage. Participants began smoking at an average age of 16 years and smoked about 20 cigarettes per day when entering the TTP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The process of tobacco cessation is simulated under different alternatives: no intervention, the current TTP (bupropion, nicotine gum and counselling), an expanded TTP that incorporates nicotine patches as a replacement therapy, and a potential future programme with cytisine and counselling (with and without mortality adjustments).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>We focus on Uruguay, which has been recognised as a global leader in tobacco control, including 100% smoke-free environments, a full advertising ban, plain packaging and steady tax increases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>We compare cost-effectiveness of policy alternatives using years of life lost (YLL) and incremental cost-effectiveness ratios, comparing policy alternatives with no intervention and the current tobacco cessation programme in the country. The analysis considers the direct costs of treatments for smoking-related diseases (healthcare perspective) as well as social costs resulting from loss of productivity (societal perspective).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The results indicate that all policy interventions lead to a reduction in the YLL compared with no intervention. Among these options, the inclusion of cytisine emerges as the most cost-effective choice. In a scenario including the transition probabilities from the TTP cohort, this alternative would result in a 10.9% reduction in YLL, with a particularly positive impact among women (\u221216.5% vs \u22124.0% in men). In terms of cost-effectiveness, the costs per YLL averted would be on average US$3991 per YLL from a healthcare perspective, and US$3773 per YLL from a societal perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Tobacco cessation programmes in Uruguay are highly cost-effective, and our results justify their expansion and optimisation. The incorporation of cytisine into the TTP and a focus on groups with more severe tobacco consumption are recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113050","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T17:10:16Z","timestamp":1771953016000},"page":"e113050","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Markov-model cost-effectiveness evaluation of a cessation programme when tobacco policies are comprehensive"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3724-9865","authenticated-orcid":false,"given":"Irene","family":"Mussio","sequence":"first","affiliation":[{"name":"Department of Economics, Leeds University Business School, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Triunfo","sequence":"additional","affiliation":[{"name":"Departamento de Econom\u00eda, Universidad de la Republica Uruguay, Montevideo, Uruguay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"Gerstenbl\u00fcth","sequence":"additional","affiliation":[{"name":"Departamento de Econom\u00eda, Universidad de la Republica Uruguay, Montevideo, Uruguay"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"2026022409101101000_16.2.e113050.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199809033391006"},{"key":"2026022409101101000_16.2.e113050.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0148750","article-title":"Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases","volume":"11","author":"Cadier","year":"2016","journal-title":"PLoS One"},{"key":"2026022409101101000_16.2.e113050.3","doi-asserted-by":"publisher","DOI":"10.1186\/S12962-021-00301-8\/TABLES\/5"},{"key":"2026022409101101000_16.2.e113050.4","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1007\/s10198-019-01105-7","article-title":"Cost-effectiveness of smoking cessation programs for hospitalized patients: a systematic review","volume":"20","author":"Lee","year":"2019","journal-title":"Eur J Health Econ"},{"key":"2026022409101101000_16.2.e113050.5","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab002"},{"key":"2026022409101101000_16.2.e113050.6","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2009.131631"},{"key":"2026022409101101000_16.2.e113050.7","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.3927","article-title":"Cost-effectiveness of a Smoking Cessation Intervention for Parents in Pediatric Primary Care","volume":"4","author":"Drouin","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026022409101101000_16.2.e113050.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1211128"},{"key":"2026022409101101000_16.2.e113050.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.285112"},{"key":"2026022409101101000_16.2.e113050.10","doi-asserted-by":"crossref","unstructured":"Gerstenbl\u00fcth M , Triunfo P . 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