Assessing the Cost-Effectiveness of Very Brief Advice for Tobacco Smoking Reduction in Kyrgyzstan: A FreshAir4Life study

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.