BACKGROUND: The illicit bidi trade in India undermines tobacco control efforts, contributes to significant revenue losses, and perpetuates unregulated production and consumption. This poses substantial challenges to public health and the enforcement of tobacco control policies. This study evaluates the cost-effectiveness of interventions aimed at controlling the illicit bidi trade.
METHODS: A cost-effectiveness analysis was conducted using a decision-analytic model to compare interventions, including enhanced supply chain monitoring, and technology-driven solutions like digital track and trace systems. Data on intervention costs, revenue recovery, and health outcomes i.e. Disability-Adjusted Life Years [DALYs] averted were obtained from government reports, peer-reviewed literature, and economic modelling. Incremental Cost-Effectiveness Ratios (ICERs) were calculated using the cost variable of the interventions and from the existing literature.
RESULTS: The analysis found that implementing digital tracking systems and strengthening enforcement mechanisms were the most cost-effective interventions, with ICERs below the threshold of India’s per capita GDP. The ICER of 0.1026 suggests that for each additional DALY averted, the cost is ₹0.1026. These interventions demonstrated significant potential for reducing illicit trade, improving tax compliance, and decreasing bidi consumption. Public awareness campaigns enhanced the effectiveness of enforcement measures when implemented concurrently, while standalone efforts yielded limited impact. The combined approach resulted in substantial reductions in DALYs, increased government revenue, and improved regulatory compliance.
CONCLUSIONS: Stronger enforcement mechanisms, coupled with digital tracking and public awareness initiatives, are highly cost-effective strategies for curbing the illicit bidi trade. Policymakers should prioritize a multi-pronged approach to maximize health and economic outcomes while addressing the regulatory gaps enabling illicit trade. Further studies should explore the long-term sustainability of these interventions and assess their impact on informal bidi sector workers.