The Collaborative Funding Program for Southeast Asia Tobacco Control Research

TOBACCO-RELATED SOCIO-ECONOMIC COST OF STROKE, LUNG CANCER AND COPD IN LAOS

Assoc. Prof. Vang Chu, M.D., Ph.D. Thanakhanh Southammavong, M.D. Pheng Sackda, M.D. Xaysana Sombandith, M.D., M,Sc, Snong Thongsna, M.D. M.MedSc. Bounmy Sisamouth, M,D. MSc. Sisouphanh Vidhamaly, M.D., MSc.

Financial support from Research for International Tobacco Control (RITC) of the International Development Research Centre (IDRC)

TOBACCO-RELATED SOCIO-ECONOMIC COST OF STROKE, LUNG CANCER AND COPD IN LAOS

Research Team Assoc. Prof. Vang Chu, M.D., Ph.D. Thanakhanh Southammavong, M.D. Pheng Sackda, M.D. Xaysana Sombandith, M.D., MSc. Snong Thongsna, M.D. MMedSC. Bounmy Sisamouth, M.D. MSc. Sisouphanh Vidhamaly, M.D.., MSc.

Principal investigator Administrator research team member research team member research team member research team member research team member

Vongsinh Phothisansack, M.D. Mittapab hospital site coordinator Somchanh Oulalay, M.D. Sethathirath hospital site coordinator Phouratsamy, M.D. Mahosot Hospital site coordinator Assoc. Prof. Khamthavy Frichittavong, M.D.Mahosot Hospital site coordinator Other nursing staff from the Mahosot, Mittapab and Sethathirath hospitals

Supported by

Southeast Asia Tobacco Control Alliance (SEATCA) Under The Collaborative Funding Program for Tobacco Control Research and

Research Institute for Tobacco Control (RITC) of the International Development Research Centre (IDRC)

February 2009

ACKNOWLEDGEMENTS This study could not have been carried out successfully without the assistance of many friends, colleagues and institutions. On behalf of the Lao tobacco research team, I would like to acknowledge the Research for International Tobacco Control (RITC) of the International Development Ressearch Centre (IDRC) in Canada, and the Southeast Asia Tobacco Control Alliance (SEATCA), for funding this tobacco-related diseases research project that enabled the research team to coordinate key officials in all target hospital facilities as well as to conduct capacity building workshops to carry out this project successfully. I would like to express my appreciation for the assistance provided by Ms. Bungon Ritthiphakdee, the Director of Southeast Asia Tobacco Control Alliance (SEATCA), Ms. Menchi G. Velasco, Research Program Manager of SEATCA, Dr. Maniphanh Vongphosy from Adventist Development and Relief Agency in Lao PDR (ADRA Lao), and Dr. Bounlonh Ketsouvannasane, from Tobacco Free Initiative (TFI) WHO LAO PDR), to our research team for this research project. I owe special thanks our external experts, Dr. Hana Ross, of the American Cancer Society (ACS), Dr. Maytry Senchanthixay, the Acting Director of the Planning Division of the Lao Ministry of Health, Dr. Dang Vu Trung, from the Hanoi School of Public Health (HSPH) in Vietnam, and Dr. Pham Hoang Anh from HealthBridge Canada in Vietnam, for their intelligent guidance and constructive opinions during the processes of our study and for providing technical assistance, especially on the health economic aspects of assessing and calculating the burden and socio-economic impacts of tobacco-related diseases of this project. Finally, special thanks are extended to all the staff from the Department of Medicine of the Sethathirath, Mittapab and Mahosot hospitals who were involved as data collectors in this study. Without their participation and sacrifice we would not have been able to gather sufficient data for this study.

Assoc. Prof. Vang Chu, M.D., Ph.D. Principal Investigator

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EXECUTIVE SUMMARY BACKGROUND AND PURPOSE: Tobacco is becoming one of the single biggest causes of death worldwide. By 2030 it is expected to kill 10 million people per year and developing countries will account for 70% of all tobacco deaths. Previous tobacco studies performed in Laos, have reported the rate of active smoking in Lao population. However, no data concerning the burden and socio-economic impact of tobaccorelated diseases in Laos, is available as yet. The aims of this study are to determine the burden of active tobacco-related socio-economic cost of stroke, lung cancer and chronic obstructive pulmonary diseases (COPD) in Laos and to estimate the burden and national socio-economic impact of tobacco-related diseases. METHODS: This is a cross-sectional and multi-centered study using a purposive sampling method. One hundred and nine patients hospitalized in Mahosot, Mittapab and Sethathirath hospitals due to cerebral thrombosis, lung cancer and COPD were included. A structured questionnaire form was used to collect data on tobacco smoking behavior, and direct and indirect costs during hospitalization. Data were provided by patients and/or the patient’s close care giver. Mean cost per event for each disease was calculated and national smoking attributable fraction costs (SAF) of these tobacco-related diseases were estimated. Data entering, cleaning, processing and analysis were performed using the Epi Info statistical package. RESULTS: The rate of tobacco smoking was 87% for lung cancer, 65% for COPD and 42% for stroke. Tobacco smoking was strongly associated with these major chronic diseases (p