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Health benefits of 20 years of tobacco tax increases modelled

Continuing annual 10% tobacco tax increases in New Zealand until 2031 should lead to health gains, net health-system cost savings and modest reductions of about 2% to 3% in health inequalities between Māori and non-Māori, according to a new study published by University of Otago, Wellington, researchers.

The research by Professor Tony Blakely and colleagues is published this week in the international journal PLOS Medicine.

The researchers estimated quality-adjusted life-years (QALYs; a measure of disease burden that includes both duration and quality of life) gained, and net health system costs, over the remaining life of New Zealand’s 2011 population exposed to annual 10% tobacco tax increases for 20 years.

The model included 16 tobacco-related diseases in parallel using national data on all-cause mortality and morbidity (illness). In 2011 smoking prevalence was 35% for Māori and 14% for non-Māori.

Compared to the 2011 population simulated into the future with no tax increases, the researchers estimated that 260,000 QALYs would be gained if the population were exposed to the annual tax increases, with net health system cost savings of around NZ$ 3.87 billion (due to prevention of tobacco-related diseases).

“This health gain of 260,000 QALYs is 17% of all health gain that we estimated would occur if all smokers in 2011 quit that year, and we followed or simulated the population into the future,” says Professor Blakely.

The QALY gains per capita associated with annual tobacco tax increases were 3.7 fold higher for Māori than for non-Māori because of higher smoking levels and likely greater price sensitivity among Māori.

Professor Blakely says the health gains and cost savings are not predicted to peak for several decades.

“This is because smoking is more common among younger age groups and the tobacco tax effect is greater among young people, given their limited disposable income.

“These young people would not reap the maximum benefits from reduced rates of tobacco-related diseases for many decades to come, due to the long delay between taking up smoking and the incidence of tobacco-related disease in individuals,” he says.

As with all modelling studies, the accuracy of these findings depends on the assumptions built into the model and the data fed into it.

Professor Blakely says this modelling work has suggested that ongoing tobacco tax increases deliver sizeable health gains and health sector cost savings, and are likely to reduce health inequalities.

“However, if policy-makers are to also achieve more rapid reductions in the non-communicable diseases (NCD) burden and health inequalities, they need to complement tobacco tax increases with additional tobacco control interventions focused on cessation among middle-age and older smokers.”

The study authors are supported by the BODE3 Programme, which is investigating the effectiveness and cost-effectiveness of various tobacco control strategies and receives funding support from the Health Research Council of New Zealand.

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