A Cost-Effectiveness Analysis of the First Federally Funded U.S. Antismoking National Media Campaign: Tips from Former Smokers

In 2012, the Centers for Disease Control and Prevention (CDC) launched the first federally funded U.S. antismoking national media campaign. Funded through the Prevention and Public Health Fund of the 2010 Patient Protection and Affordable Care Act, the 2012 Tips from Former Smokers (Tips) was on air from March 19th through June 10th. Ads featured hard-hitting, graphic, and emotional testimonials from former smokers about living with the harsh physical consequences of smoking-related diseases. Tips ads were aimed at increasing public awareness of the immediate and longer-term health damage caused by smoking and exposure to secondhand smoke, encouraging smokers to quit, and motivating nonsmokers to communicate with family and friends about the dangers of smoking. Tips ads were delivered via television, radio, print (magazines), out-of-home, theater, and digital media. All ads provided free resources to help quitting, including the national quitline number (1-800-QUIT-NOW) or a website (www.smokefree.gov).  The 2012 Tips campaign was effective in increasing population-level quit attempts. Recent analyses show that the Tips campaign generated an estimated 1.6 million new quit attempts among U.S. adult smokers and approximately 100,000 sustained quits of 6 months or more. Despite this success, it is unclear whether the costs associated with the development, implementation, and evaluation of the campaign can be justified by campaign-attributable health benefits. Although a few studies have concluded that antismoking media campaigns at the state and local levels have shown efficacy in motivating smokers to quit and can be cost-effective, national campaigns can be more economically efficient than state or local campaigns because of economics of scale.  To address this issue, we conducted a cost-effectiveness analysis to evaluate the campaign from a funder’s perspective. Specifically, the cost was assessed based on the campaign-specific expenditure born by CDC, and the cost-effectiveness of the campaign was evaluated by four measures: (1) the cost per successful quit; (2) the cost per premature death averted; (3) the cost per undiscounted life year (LY) saved; and (4) the cost per discounted quality-adjusted life year (QALY) gained.  Findings suggest that the campaign was not only successful at reducing smoking-attributable morbidity and mortality, but was a highly cost-effective way of achieving these outcomes. Conservatively, the 2012 Tips saved about 163,900 QALYs and prevented 14,830 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $3,230 per premature death averted, $260 per LYs saved, and $290 per QALY gained, comparing very favorably to a generally accepted cost-effectiveness threshold ($50,000 per QALY).  These findings provide evidence that a national, federally-funded mass media campaign can be a highly cost-effective way to reduce the burden of tobacco use. Policy makers, public health officials, and clinicians can face limited resources as they work to reduce the enormous human and financial toll of tobacco use. It is therefore important to identify interventions that have a large impact for a relatively small cost. Continued implementation of hard-hitting mass media campaigns can reduce the burden of tobacco use and generate interest in quitting.