Impact of increasing tobacco taxes on working-age adults: short-term health gain, health equity and cost savings

ObjectiveThe health gains and cost savings from tobacco tax increase peak many decades into the future. Policy-makers may take a shorter-term perspective and be particularly interested in the health of working-age adults (given their role in economic productivity). Therefore, we estimated the impact of tobacco taxes in this population within a 10-year horizon.MethodsAs per previous modelling work, we used a multistate life table model with 16 tobacco-related diseases in parallel, parameterised with rich national data by sex, age and ethnicity. The intervention modelled was 10% annual increases in tobacco tax from 2011 to 2020 in the New Zealand population (n=4.4 million in 2011). The perspective was that of the health system, and the discount rate used was 3%.ResultsFor this 10-year time horizon, the total health gain from the tobacco tax in discounted quality-adjusted life years (QALYs) in the 20–65 year age group (age at QALY accrual) was 180 QALYs or 1.6% of the lifetime QALYs gained in this age group (11 300 QALYs). Nevertheless, for this short time horizon: (1) cost savings in this group amounted to NZ$10.6 million (equivalent to US$7.1 million; 95% uncertainty interval: NZ$6.0 million to NZ$17.7 million); and (2) around two-thirds of the QALY gains for all ages occurred in the 20–65 year age group. Focusing on just the preretirement and postretirement ages, the QALY gains in each of the 60–64 and 65–69 year olds were 11.5% and 10.6%, respectively, of the 268 total QALYs gained for all age groups in 2011–2020.ConclusionsThe majority of the health benefit over a 10-year horizon from increasing tobacco taxes is accrued in the working-age population (20–65 years). There remains a need for more work on the associated productivity benefits of such health gains.