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Cost-effectiveness of a smokeless tobacco control mass media campaign in India
  1. Nandita Murukutla1,
  2. Hongjin Yan1,
  3. Shuo Wang1,
  4. Nalin Singh Negi1,
  5. Alexey Kotov1,
  6. Sandra Mullin1,
  7. Mark Goodchild2
  1. 1 Vital Strategies, New York, USA
  2. 2 World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr Nandita Murukutla, Vital strategies, 61 Broadway, Suite 2800, New York, NY 10006, USA; nmurukutla{at}


Background Tobacco control mass media campaigns are cost-effective in reducing tobacco consumption in high-income countries, but similar evidence from low-income countries is limited. An evaluation of a 2009 smokeless tobacco control mass media campaign in India provided an opportunity to test its cost-effectiveness.

Methods Campaign evaluation data from a nationally representative household survey of 2898 smokeless tobacco users were compared with campaign costs in a standard cost-effectiveness methodology. Costs and effects of the Surgeon campaign were compared with the status quo to calculate the cost per campaign-attributable benefit, including quit attempts, permanent quits and tobacco-related deaths averted. Sensitivity analyses at varied CIs and tobacco-related mortality risk were conducted.

Results The Surgeon campaign was found to be highly cost-effective. It successfully generated 17 259 148 additional quit attempts, 431 479 permanent quits and 120 814 deaths averted. The cost per benefit was US$0.06 per quit attempt, US$2.6 per permanent quit and US$9.2 per death averted. The campaign continued to be cost-effective in sensitivity analyses.

Conclusion This study suggests that tobacco control mass media campaigns can be cost-effective and economically justified in low-income and middle-income countries. It holds significant policy implications, calling for sustained investment in evidence-based mass media campaigns as part of a comprehensive tobacco control strategy.

  • Media
  • Economics
  • Prevention
  • Low/Middle income country
  • Advocacy

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  • Contributors NM: Study design, oversight of impact evaluation study, design and direction of data analysis, data interpretation, literature review;, writing of this paper. HY: Design of analysis, conduct of the analysis, help in writing the paper. SW: Design of analysis, conduct of the analysis, help in writing the paper. NSN: Review of the analysis, help in writing the paper. AK: Review of the analysis, help in writing the paper. SM: Review of the analysis, help in writing the paper. MG: Guidance on the development of the model, review and contributions towards the analysis, writing of this paper.

  • Funding The impact evaluation and analysis was supported by a grant from the Bloomberg Philanthropies to Vital Strategies (formerly known as World Lung Foundation). However, Bloomberg Philanthropies was not involved in any aspect of the evaluation study or the writing of this manuscript. The authors have not been paid to write this article.

  • Disclaimer The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions or polices of the institutions with which they are affiliated.

  • Competing interests None declared.

  • Ethics approval Prior to participation, the study was described to all participants and their formal consent to participate was sought. The questionnaire was administered only to respondents who agreed to participate in this research. As an ESOMAR member, ORG-Nielsen complies with the professional and ethical standards of ESOMAR International Code of Marketing and Social Research Practice.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. Some of the confidence intervals in the tables were initially misreported.