OBJECTIVES: Economic evaluations of tobacco control interventions can provide important inputs for decision-making regarding resource allocation. However, it requires reliable simulation models. Our systematic review was aimed at identifying potential bias entailed in decision models used in the field of health economics to estimate the long-term costs and effects of tobacco control interventions in Asia.

METHODS: We conducted four searches of major databases, the last of which took place in November 2019. In our searches, we included studies conducted in Asian countries using a modelling technique to evaluate the economic impacts of one or more population-based tobacco interventions in line with the Framework Convention on Tobacco Control (FCTC). We assessed the structures, input parameters, and risk of bias for each model and developed a narrative synthesis of the included studies.

RESULTS: We identified a total of nine model-based economic evaluation studies of population-based tobacco interventions conducted in Asia. About 60% of the criteria for assessing the reporting quality were met in all of the studies, indicating that the reporting demonstrated a general lack of transparency. The studies were highly heterogeneous in terms of the scope, types, and structures of their models and the quality of input parameters. One-third of the models applied in the studies appeared to entail a high risk of bias, with identified problems mostly falling into the following categories: choice of model type, limited time horizons, and inaccurate estimates of baseline data used for determining the transition probabilities.

CONCLUSIONS: More epidemiological and empirical studies are needed to support high-quality evidence regarding the cost-effectiveness of tobacco control policies in Asia. Strong evidence at the country level hinges on the availability of accurate estimates of the effects of the interventions, the relative risks of smoking, and the price elasticity of the demand for tobacco.