Background:
Tobacco control (TC) mass media campaigns (MMCs) are an important component of tobacco control strategies and are effective in reducing smoking prevalence. However, with increasing pressure on public health budgets, there has been a shift in some countries from MMCs to much cheaper community-based initiatives.

Methods:
Using multivariate time series analyses we examined the relationships between exposure to TV MMCs (adult TV viewer ratings (TVRs); and quitting behaviour (calls to Smokeline, prescriptions for NRT), and reduction in numbers of smokers. In the economic analysis, we compared the costs and effects of TV MMCs against a 'No TV/do-nothing' alternative, from a public sector payer perspective (Scottish Government and NHS).

Results:
TV MMCs increased calls to Smokeline by 385.9 calls (95% CI, 171.0 - 600.7) per 1 SD TVRs (194). This was sustained for 6 months. Adverts that evoked positive feelings generated the largest increase in calls (69.7%: 46.1, 93.0). The increase in NRT prescriptions was insignificant (£1,361.4: -£9,138 - £11,860.9). An increase of one TVR/month reduced the number of smokers by 41 (- 40.9: -102.07, 20.24). Although, statistically insignificant, our economic analysis indicates that TV MMCs generated an additional 116,885 quit attempts and 7,305 sustained 52-week quits per annum compared with no TV MMCs. The incremental cost per 52-week quitter was £102, which is highly cost-effective. With the very low annual cost of TV MMCs of £0.66 per smoker and potential lifetime savings in terms of avoiding cost of smoking related diseases, the lifetime model resulted in overall cost savings (-£319:-£974,-£31) and QALY gains (0.016: 0.0017,0.048) that were significant and demonstrated little uncertainty.

Conclusions:
This study provides convincing evidence that tobacco control TV MMCs can increase quit attempts and are both effective and cost-effective in reducing the number of smokers. Their continued use, as part of a comprehensive TC strategy, is strongly recommended.