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Modelling the implications of reducing smoking prevalence: the public health and economic benefits of achieving a ‘tobacco-free’ UK
  1. Daniel Hunt1,
  2. André Knuchel-Takano2,
  3. Abbygail Jaccard2,
  4. Arti Bhimjiyani3,
  5. Lise Retat2,
  6. Chit Selvarajah1,
  7. Katrina Brown4,
  8. Laura L Webber2,
  9. Martin Brown2
  1. 1 Department of Prevention, Cancer Research UK, London, UK
  2. 2 Department of Public Health Modelling, UK Health Forum, London, UK
  3. 3 School of Clinical Sciences, University of Bristol, Bristol, UK
  4. 4 Department of Analysis and Evaluation, Cancer Research UK, London, UK
  1. Correspondence to Dr Laura L Webber, UK Health Forum, Fleetbank House, 2-6 Salisbury Square, London, EC4Y 8JX, UK; laura.webber{at}


Introduction Smoking is still the most preventable cause of cancer, and a leading cause of premature mortality and health inequalities in the UK. This study modelled the health and economic impacts of achieving a ‘tobacco-free’ ambition (TFA) where, by 2035, less than 5% of the population smoke tobacco across all socioeconomic groups.

Methods A non-linear multivariate regression model was fitted to cross-sectional smoking data to create projections to 2035. These projections were used to predict the future incidence and costs of 17 smoking-related diseases using a microsimulation approach. The health and economic impacts of achieving a TFA were evaluated against a predicted baseline scenario, where current smoking trends continue.

Results If trends continue, the prevalence of smoking in the UK was projected to be 10% by 2035—well above a TFA. If this ambition were achieved by 2035, it could mean 97 300 +/- 5 300 new cases of smoking-related diseases are avoided by 2035 (tobacco-related cancers: 35 900+/- 4 100; chronic obstructive pulmonary disease: 29 000 +/- 2 700; stroke: 24 900 +/- 2 700; coronary heart disease: 7600 +/- 2 700), including around 12 350 diseases avoided in 2035 alone. The consequence of this health improvement is predicted to avoid £67 +/- 8 million in direct National Health Service and social care costs, and £548 million in non-health costs, in 2035 alone.

Conclusion These findings strengthen the case to set bold targets on long-term declines in smoking prevalence to achieve a tobacco ‘endgame’. Results demonstrate the health and economic benefits that meeting a TFA can achieve over just 20 years. Effective ambitions and policy interventions are needed to reduce the disease and economic burden of smoking.

  • End game
  • tobacco-free
  • tobacco microsimulation
  • disease burden
  • economic burden

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  • Contributors All authors were involved in the design of the study. AKT, AB and LW provided information on the study methodology and data inputs and outputs, and DH wrote the introduction, discussion and policy components of this paper. AKT, DH, KB, AJ, LR and LW have contributed to manuscript revisions. AJ, LR and MB developed the model methodology, including development of algorithms and model assumptions.

  • Funding The research was commissioned by Cancer Research UK.

  • Competing interests AKT and AB worked at the UK Health Forum when this research was undertaken. No other interests are declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.