BACKGROUND: Bidi consumption, a predominant form of tobacco use in India, poses significant public health and economic burdens, contributing to a high prevalence of tobacco-related diseases and mortality. Effective interventions to reduce bidi consumption are crucial, yet evidence on their cost-effectiveness remains limited. This study aims to evaluate the cost-effectiveness of interventions targeting bidi consumption control in India.
METHODS: A cost-effectiveness analysis was conducted using a decision-analytic model to compare different intervention strategies, including taxation, public awareness campaigns, cessation programs, and regulatory measures. Data on intervention costs and health outcomes were sourced from peer-reviewed studies, government reports, and national health databases. Incremental Cost-Effectiveness Ratios (ICERs) were calculated, and a societal perspective was adopted for the analysis.
RESULTS: The analysis revealed that increasing taxation on bidis was the most cost-effective intervention, with an ICER well below the threshold of India's per capita GDP. For every additional 23.73 USD spent on the intervention 1 Year of Life Lost (YLL) is prevented. Public awareness campaigns and cessation programs demonstrated moderate cost-effectiveness but were more impactful when combined with taxation measures. Regulatory enforcement targeting informal bidi production showed potential but required substantial initial investments. All interventions led to significant reductions in DALYs and healthcare costs, highlighting their potential for long-term economic and public health benefits.
CONCLUSIONS: Taxation emerged as the most cost-effective intervention for controlling bidi consumption, with synergistic effects observed when combined with awareness and cessation strategies. Policymakers should prioritize these interventions to maximize health outcomes and economic efficiency. Further research is recommended to evaluate the long-term sustainability of these strategies and explore alternative livelihoods for bidi workers to ensure equitable implementation.