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      Economic cost of tobacco-related cancers in Sri Lanka

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          Abstract

          Introduction

          Cancer has a high mortality rate and morbidity burden in Sri Lanka. This study estimated the economic cost of smoking and smokeless tobacco (ST) related to cancers in Sri Lanka in 2015.

          Methods

          Prevalence-based cost of illness is calculated according to the guidelines of the WHO (2011). The direct costs are costs of curative care (costs of inward patients and outpatient care borne by the state and out of pocket expenditure by households) for tobacco-related cancers, weighted by the attributable fractions for these cancers. Indirect costs are lost earnings due to mortality and morbidity (absenteeism of both patient and carers resulting from seeking care and recuperation).

          Data were obtained from the Registrar General’s Department, National Cancer Registry, Department of Census and Statistics and the Central Bank of Sri Lanka. Household and systemic costs and relative risks were extracted from research studies. Oncologists (working in both public and private sectors), other clinical specialists, medical administrators and economists were consulted during the estimation and validation processes.

          Results

          The total economic cost of tobacco-related cancers for Sri Lanka in 2015 was estimated to be US$121.2 million. The direct cost of smoking and ST-related cancers was US$42.1 million, which was 35% of the total cost, while the indirect cost was US$79.1 million, which was 65% of the total cost.

          Conclusion

          Burden of tobacco smoking and ST-related cancers as reflected in these economic costs is enormous: affecting the healthcare system and country’s economy. Policymakers should take note of this burden and address tobacco consumption control as a priority.

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          Most cited references13

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          Tobacco smoking and cancer: a meta-analysis.

          We conducted a systematic meta-analysis of observational studies on cigarette smoking and cancer from 1961 to 2003. The aim was to quantify the risk for 13 cancer sites, recognized to be related to tobacco smoking by the International Agency for Research on Cancer (IARC), and to analyze the risk variation for each site in a systematic manner. We extracted data from 254 reports published between 1961 and 2003 (177 case-control studies, 75 cohorts and 2 nested case-control studies) included in the 2004 IARC Monograph on Tobacco Smoke and Involuntary Smoking. The analyses were carried out on 216 studies with reported estimates for 'current' and/or 'former' smokers. We performed sensitivity analysis, and looked for publication and other types of bias. Lung (RR = 8.96; 95% CI: 6.73-12.11), laryngeal (RR = 6.98; 95% CI: 3.14-15.52) and pharyngeal (RR = 6.76; 95% CI: 2.86-15.98) cancers presented the highest relative risks (RRs) for current smokers, followed by upper digestive tract (RR = 3.57; 95% CI: 2.63-4.84) and oral (RR = 3.43; 95% CI: 2.37-4.94) cancers. As expected, pooled RRs for respiratory cancers were greater than the pooled estimates for other sites. The analysis of heterogeneity showed that study type, gender and adjustment for confounding factors significantly influence the RRs estimates and the reliability of the studies. Copyright 2007 Wiley-Liss, Inc.
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            Betel quid chewing and the risk of oral and oropharyngeal cancers: a meta-analysis with implications for cancer control.

            We conducted a random-effects meta-analysis of 50 publications assessing the relationship between oral/oropharyngeal cancer and chewing betel quid, with (BQ+T) or without added tobacco (BQ-T), a common practice in many parts of Asia and globally among Asian immigrants. Exposure-response, by daily amount and years of BQ chewed, was assessed using spline models. Attributable fractions (PAF%) were calculated to estimate the public health impact if BQ were no longer chewed. The meta-relative risk (mRR) for oral/oropharyngeal cancer in the Indian subcontinent was 2.56 (95%CI, 2.00-3.28; 15 studies) for BQ-T and 7.74 (95%CI, 5.38-11.13; 31 studies) for BQ+T; in Taiwan, China, the mRR for BQ-T was 10.98 (95%CI, 4.86-24.84; 13 studies). Restricting to studies that adjusted for tobacco and alcohol use had only a small effect on the risk estimates. For BQ+T in the Indian subcontinent, the mRR was much higher in women (mRR, 14.56; 95%CI, 7.63-27.76) than in men. Exposure-response analyses showed that the risk of oral/oropharyngeal cancer increased with increasing daily amount and duration (years) of chewing BQ in India and Taiwan, China. Roughly half of oral cancers in these countries could be prevented if BQ were no longer chewed (PAF%=53.7% for BQ-T in Taiwan, China; PAF%=49.5% for BQ+T in India). We demonstrate that betel quid chewing, with or without added tobacco, increases the risk of oral/oropharyngeal cancer in an exposure-dependent manner, independently of tobacco and alcohol use. Further work is needed to explain the higher risks associated with chewing BQ-T in Taiwan, China. © 2013 UICC.
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              Tobacco, oral cancer, and treatment of dependence.

              Tobacco dependence is recognised as a life-threatening disorder with serious oral health consequences which responds to treatment in the form of behavioural support and medication. While cigarette smoking is the most hazardous and prevalent form of tobacco use in the west, consideration also needs to be given to other forms such as bidi smoking in India, reverse smoking by several rural populations and use of snuff and chewing tobacco. The evidence that the use of tobacco is the major risk factor for oral cancer and potentially malignant lesions of the mouth is clear. Counseling to quit smoking is not applied in a systematic or frequent manner to people presenting with potentially malignant lesions of the oral cavity. This review makes recommendations for interventions by health professionals to encourage and aid cessation of tobacco use as a part of prevention of oral cancer.
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                Author and article information

                Journal
                Tob Control
                Tob Control
                tobaccocontrol
                tc
                Tobacco Control
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0964-4563
                1468-3318
                September 2018
                27 October 2017
                : 27
                : 5
                : 542-546
                Affiliations
                [1 ] departmentMinistry of Health, Nutrition and Indigenous Medicine , Institute of Oral Health , Maharagama, Sri Lanka
                [2 ] Sri Lanka Medical Association , Colombo, Sri Lanka
                [3 ] World Health Organization , Colombo, Sri Lanka
                [4 ] departmentMinistry of Health, Nutrition and Indigenous Medicine , National Authority on Tobacco and Alcohol , Battaramulla, Sri Lanka
                [5 ] departmentDepartment of Pharmacy, Faculty of Pharmacy , Mahidol University , Bangkok, Thailand
                [6 ] University of Colombo , Colombo, Sri Lanka
                Author notes
                [Correspondence to ] Dr Hemantha Amarasinghe, Ministry of Health, Nutrition and Indigenous Medicine, Institute of Oral Health, Maharagama, Sri Lanka; hemanthaamarasinghe@ 123456yahoo.com

                Original reference: None

                Article
                tobaccocontrol-2017-053791
                10.1136/tobaccocontrol-2017-053791
                6109234
                29079585
                d92f2bef-7901-4a88-a317-c3a5e66887e0
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                : 06 April 2017
                : 20 August 2017
                : 23 August 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;
                Categories
                Research Paper
                1506
                Custom metadata
                unlocked

                Public health
                economics,public policy,smoking caused disease,non-cigarette tobacco products
                Public health
                economics, public policy, smoking caused disease, non-cigarette tobacco products

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