title: Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand.
abstract: BACKGROUND
  Countries are increasingly considering how to reduce or even end tobacco consumption, and raising tobacco taxes is a potential strategy to achieve these goals. We estimated the impacts on health, health inequalities, and health system costs of ongoing tobacco tax increases (10% annually from 2011 to 2031, compared to no tax increases from 2011 ["business as usual," BAU]), in a country (New Zealand) with large ethnic inequalities in smoking-related and noncommunicable disease (NCD) burden.
  
  
  RESULTS
  We modeled 16 tobacco-related diseases in parallel, using rich national data by sex, age, and ethnicity, to estimate undiscounted quality-adjusted life-years (QALYs) gained and net health system costs over the remaining life of the 2011 population (n = 4.4 million). A total of 260,000 (95% uncertainty interval [UI]: 155,000-419,000) QALYs were gained among the 2011 cohort exposed to annual tobacco tax increases, compared to BAU, and cost savings were US$2,550 million (95% UI: US$1,480 to US$4,000). QALY gains and cost savings took 50 y to peak, owing to such factors as the price sensitivity of youth and young adult smokers. The QALY gains per capita were 3.7 times greater for Māori (indigenous population) compared to non-Māori because of higher background smoking prevalence and price sensitivity in Māori. Health inequalities measured by differences in 45+ y-old standardized mortality rates between Māori and non-Māori were projected to be 2.31% (95% UI: 1.49% to 3.41%) less in 2041 with ongoing tax rises, compared to BAU. Percentage reductions in inequalities in 2041 were maximal for 45-64-y-old women (3.01%). As with all such modeling, there were limitations pertaining to the model structure and input parameters.
  
  
  CONCLUSIONS
  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 achieve more rapid reductions in the NCD burden and health inequalities, they will also need to complement tobacco tax increases with additional tobacco control interventions focused on cessation.
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Tony
authors.initials: T
authors.lastname: Blakely
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand; British Heart Foundation Centre on Population Approaches to NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Cobiac
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Cleghorn
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand; Department of Geography, Michigan State University, East Lansing, Michigan, United States of America.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Pearson
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Frederieke S
authors.initials: FS
authors.lastname: van der Deen
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Kvizhinadze
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Nhung
authors.initials: N
authors.lastname: Nghiem
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Melissa
authors.initials: M
authors.lastname: McLeod
authors.affiliation: Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Nick
authors.initials: N
authors.lastname: Wilson
mesh_terms: D000328:Adult; D066275:Health Information Exchange; D054624:Health Status Disparities; D006801:Humans; D015993:Life Tables; D018803:Models, Economic; D009520:New Zealand; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000191:economics* / Q000401:mortality*; D016540:Smoking Cessation / Q000191:economics / Q000331:legislation & jurisprudence; D013660:Taxes / Q000639:trends*