Tobacco Endgame Simulation Modelling: Assessing the Impact of Policy Changes on Smoking Prevalence in 2035

Abstract

Smoking causes substantial amount of mortality and morbidity. This article presents the findings from simulation models that projected the impact of five potential Tobacco Endgame strategies on smoking prevalence in Ontario by 2035 and expected impact of smoking prevalence “less than 5 by 35” on tax revenue. We used Ontario SimSmoke simulation for modelling the expected impact of four strategies: plain packaging, free cessation services, decreasing the number of tobacco outlets, and increasing tobacco taxes. Separate models were used to project the impact of increasing the minimum age to legally purchase tobacco to 21 years on smoking prevalence and impact of price and tax increase to achieve “less than 5 by 35” on taxation revenue. The combined effect of four strategies in Ontario SimSmoke Model are expected to reduce smoking prevalence by 8.5% in 2035. Increasing tobacco taxes had the greatest independent predicted decrease in smoking prevalence (2.8%) followed by raised minimum age for legal purchase to 21 years (2.4%), decreasing tobacco outlets (1.5%), free cessation services (0.7%), and plain packaging (0.6%). Increasing tobacco excise tax and prices are projected to have minimal impact on taxation revenue, with a decrease from 1.5 billion to 1.2 billion annual tax receipts.

Closing the gaps in tobacco endgame evidence: a scoping review

“…Seven simulation modelling studies examined the potential impacts of tobacco tax increases within the context of an endgame strategy. The four modelling studies that estimated health outcomes all concluded that tax increases would result in notable population health improvements,55 59 60 62 and the four that reported changes in smoked tobacco use all estimated significant decreases in prevalence,55 60 63 64 thus demonstrating the policy could contribute to an endgame. However, the only synthesis (a modelling study) that demonstrated how a tobacco endgame could be achieved solely through raising taxes showed they would need to increase by more than 20% (above inflation) annually,64 a figure notably higher than Australia’s 12.5% annual tax increases between 2017 and 2020.…”

“…The four modelling studies that estimated health outcomes all concluded that tax increases would result in notable population health improvements,55 59 60 62 and the four that reported changes in smoked tobacco use all estimated significant decreases in prevalence,55 60 63 64 thus demonstrating the policy could contribute to an endgame. However, the only synthesis (a modelling study) that demonstrated how a tobacco endgame could be achieved solely through raising taxes showed they would need to increase by more than 20% (above inflation) annually,64 a figure notably higher than Australia’s 12.5% annual tax increases between 2017 and 2020. One synthesis concluded the policy would result in sizeable decreases in health inequalities between Māori and non-Māori people in NZ,62 and two noted decreased health system costs 60 62.…”

“…Potential limitations of the policy include some people reducing cigarettes smoked per day but not achieving cessation, or continuing to use cigarettes for a multitude of reasons other than nicotine addiction, 35 public misperceptions that VLNC cigarettes are harmful 50 and potential (short-term) negative impacts on behavioural and cognitive performance following a rapid reduction in nicotine. 36 51 Canada, 64 Singapore, 55 Solomon Islands 59 3 60…”

“…60 62 One estimated that the policy would result in substantial increases in tax revenue, 63 while another projected minimal impact on taxation revenue. 64 Another study modelled the impacts of lower taxes for VLNC cigarettes, thereby examining the use of tax measures as part of implementing another endgame policy. 65 The authors concluded this policy would reduce nicotine exposure and smoking-related healthcare costs.…”

Smoking, Health Market Equilibrium and Fiscal Policy

“…The application of and effective fiscal policy for the smoking control in the health context begins understanding the smoking impact over the health market equilibrium. The characteristics and the magnitude of this impact determine the particular characteristics from the appropriate fiscal policy for the smoking control [6].…”