"Even with deliberately conservative assumptions, tax increases that would raise the real price of cigarettes by 10 percent worldwide would prevent between 5 million and 16 million tobacco-related deaths," says lead author M. Kent Ranson, M.D., Ph.D.
To put that figure in perspective, Ranson says cigarette tax increases could save an estimated 1 percent to 4 percent of lives that are expected to be lost to tobacco-related illness.
"Low-income and middle-income countries [would] account for about 90 percent of the averted deaths," Ranson reports. And because price increases hit younger smokers hardest, he adds, the greatest savings in lives would be among smokers currently between 15 and 29 years old.
Ranson and his colleagues evaluated the effectiveness of three types of tobacco control policies in terms of the number of tobacco-related deaths they could prevent and the public health cost of preventing those deaths. To do so, they applied the results of previous tobacco-cessation research to a worldwide model of smokers in 1995.
"In general, price increases are … the most cost-effective anti-smoking intervention," the researchers report in Nicotine & Tobacco Research. The average cost to the public for saving a single year of human life would range, in U.S. dollars, between $12 and $313 globally. In low- and middle-income regions, the cost for a year of life could be as low as $3.
According to Ranson, this would make price increases as cost-effective as many health interventions already financed by governments. Child immunization, for example, costs approximately $25 per year of life saved, while each year gained using the most cost-effective intervention for reducing heart disease risk costs almost $500 for men and at least $1,760 for women.
A second alternative, liberalizing access to nicotine replacement therapy in its various forms -- including chewing gum, skin patches, nasal spray, inhalers, tablets and lozenges -- could spare between 1 million and 5 million lives from smoking-induced death, the authors estimate.
The third alternative is a package of interventions that involve neither price control nor nicotine replacement, including complete bans on advertising and promotion of tobacco products, dissemination of information on the health consequences of smoking, and restrictions on smoking in public places and work places. A package of this type that reduced smoking by only 2 percent, the authors estimate, would prevent approximately 5 million smoking-attributable deaths. That number would jump to 25 million if the package produced its maximum estimated impact of a 10 percent reduction in smoking.
The authors' calculations reveal that strategies not involving price controls would spare the most lives in low- and middle-income regions. However, nicotine replacement therapy's greatest benefit would be expected among smokers between 30 and 59 years old, while the package of non-price, non-nicotine replacement interventions probably would have maximum impact on those aged 20 to 29.
According to the team's estimates, Ranson notes, "[nicotine replacement therapy] and other non-price measures are slightly less cost-effective than price increases, but remain cost-effective in many settings."
Ultimately, he adds, "local cost-effectiveness studies are required to guide local policy" by providing more accurate estimates of the expected benefits and costs of the three tobacco control strategies.
Ranson stresses that the authors were careful not to assume "best case" scenarios in their calculations, in order to avoid inflating expected benefits and underrating actual costs. Instead, he explains, all of the researchers' assumptions intentionally "err on the conservative side, so that the potential impact of the proposed interventions is, if anything, understated."
Even so, he concludes, "the reductions in mortality are still quite impressive."
The analysis was conducted during Ranson's tenure as a Ph.D. candidate at the London School of Hygiene and Tropical Medicine. Support came from the World Health Organization, the World Bank, and the International Tobacco Evidence Network.
FOR MORE INFORMATION
Health Behavior News Service: (202) 387-2829 or http://www.hbns.org.
Interviews: Contact M. Kent Ranson at Kent.Ranson@lshtm.ac.uk.
Nicotine & Tobacco Research: Contact Gary E. Swan, Ph.D., at (650) 859-5322.
Journal
Nicotine & Tobacco Research