Assessing the cost-effectiveness of very brief advice for tobacco smoking reduction in Kyrgyzstan: a FreshAir4Life study
Rina J Ševčík, Alexander Lepe, Aizhamal Tabyshova, Maamed Mademilov, Talant M Sooronbaev, Marat Sultanov, Jurjen van der SchansAbstract
Introduction
Tobacco use, particularly smoking, is a major driver of non-communicable diseases (NCDs) and premature mortality in Kyrgyzstan. Adolescence presents a critical window for cessation support, and affordable and scalable youth-focused interventions are needed. This study assessed the cost-effectiveness of various scenarios of Very Brief Advice (VBA) implementation, an opportunistic, short cessation intervention, in which health professionals encourage cessation attempts and referral to support services among adolescents.
Methods
A dynamic population health model (DYNAMO-HIA) was used to simulate VBA’s long-term impact on disability-adjusted life years (DALYs) and avoidable healthcare costs through tobacco-related NCD prevention in Kyrgyzstan’s two most densely populated provinces. Alternative scenarios explored the impact of its delivery on cost-effectiveness by varying Reach, Effectiveness, Adoption, and Implementation (RE-AIM framework), and simulating a national upscale.
Results
VBA was highly cost-effective, at U$144 per DALY averted, generating long-term health gains at relatively low cost. Cost-effectiveness further increased under a scenario assuming enhanced intervention Effectiveness, but not Adoption, Implementation, or Reach. Though remaining cost-effective, possible implementation challenges, particularly those affecting VBA effectiveness, could reduce avoidable disease burden and lower cost-effectiveness. Results remained robust across sensitivity analyses, including lower baseline smoking prevalence.
Conclusion
The findings suggest that VBA is a highly cost-effective addition to routine adolescent healthcare in Kyrgyzstan. Degrees of cost-effectiveness varied across implementation scenarios, with Effectiveness emerging as the most influential RE-AIM domain. Maintaining the cost-effectiveness of the two-region implementation during national scale-up would likely require a stronger implementation strategy.
Implications
This study provides the first model-based cost-effectiveness estimates of Very Brief Advice (VBA) for adolescent smoking cessation and NCD prevention in a low-resource and high-burden setting such as Kyrgyzstan, filling a critical gap in locally relevant economic evidence for tobacco control. By integrating the RE-AIM framework into a health-economic model, findings offer evidence-based recommendations to help decision-makers implement VBA, and implementation teams optimize its delivery. This study demonstrates the practical value of combining implementation science and health economics in resource-constrained LMIC contexts, where anticipating implementation challenges and careful planning are essential for effective resource allocation.