The Lifetime Health and Economic Burden of Smokeless Tobacco use in Bangladesh, India, and Pakistan: Results From ASTRAMOD

Introduction:
In this article, the authors present a study that aimed to estimate the lifetime health and economic burden of smokeless tobacco (ST) use in Bangladesh, India, and Pakistan. The study used a Markov-based state-transition model (ASTRAMOD) to predict the lifetime costs of treatment of four diseases and disability-adjusted life years (DALYs) attributable to ST use. The model was populated with data from country-specific Global Adult Tobacco Surveys, life tables, and meta-analyses of South Asian and South East Asian studies.

Key Points:

* The study found that if there were no change in the current ST policies, the lifetime ST-attributable treatment costs would be over US$19 billion in India, over US$1.5 billion in Bangladesh, and over US$3 billion in Pakistan.
* The model predicted that a typical 15-year-old male adolescent would gain 0.07-0.18 life years, avert 0.07-0.19 DALYs, and generate a cost-savings of US$7-21 on healthcare spending if ST policies were changed to eliminate ST use.
* The study highlights the potential impact of policy interventions aimed at decreasing the uptake of ST and increasing quitting success, which could substantially decrease the economic and health burden of ST use.
* The study provides the most comprehensive estimates of the lifetime health and economic burden of ST by 5-year age and sex cohorts.
* The study is the first to highlight the scale of health and economic burden of ST in Bangladesh, India, and Pakistan if there were no changes in the current ST policies.
* The ASTRAMOD methodology can be used by researchers to estimate the impact of future ST policy changes.

Main Message:
The study highlights the significant economic and health burden of ST use in Bangladesh, India, and Pakistan. The results emphasize the need for policymakers and practitioners to improve current ST policies and practices. By using the ASTRAMOD methodology, researchers can estimate the impact of future ST policy changes, providing critical evidence for policymakers to make informed decisions. Overall, the study provides compelling evidence for the need for effective ST control policies and practices to reduce the health and economic burden of ST use in South Asia.

Kathryn Coyle, Prashant Kumar Singh, Ravi Kaushik, Rumana Huque, Zohaib Khan, Ravi Mehrotra, Kamran Siddiqi, Subhash Pokhrel, The Lifetime Health and Economic Burden of Smokeless Tobacco use in Bangladesh, India, and Pakistan: Results From ASTRAMOD, Nicotine & Tobacco Research, Volume 27, Issue 4, April 2025, Pages 684–692, https://doi.org/10.1093/ntr/ntae067