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Modelling the implications of reducing smoking prevalence: the benefits of increasing the UK tobacco duty escalator to public health and economic outcomes
  1. Andre Knuchel-Takano1,
  2. Daniel Hunt2,
  3. Abbygail Jaccard1,
  4. Arti Bhimjiyani3,
  5. Martin Brown1,
  6. Lise Retat1,
  7. Katrina Brown4,
  8. Sebastian Hinde5,
  9. Chit Selvarajah2,
  10. Linda Bauld2,6,
  11. Laura Webber1
  1. 1 Department of Public Health Modelling, UK Health Forum (formerly the National Heart Forum), London, UK
  2. 2 Department of Prevention, Cancer Research UK, London, UK
  3. 3 Department of Translational Health Sciences, School of Clinical Sciences, University of Bristol, Bristol, UK
  4. 4 Department of Analysis and Evaluation, Cancer Research UK, London, UK
  5. 5 Team for Economic Evaluation and Health Technology Assessment (TEEHTA), Centre for Health Economics, University of York, York, UK
  6. 6 Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
  1. Correspondence to Dr Laura Webber, Director Public Health Modelling, UK Health Forum (formerly the National Heart Forum), London, England, EC4Y 8JX, UK; laura.webber{at}


Introduction Taxing tobacco is one of the most effective ways to reduce smoking prevalence, mitigate its devastating consequential health harms and progress towards a tobacco-free society. This study modelled the health and economic impacts of increasing the existing cigarette tobacco duty escalator (TDE) in the UK from the current 2% above consumer price inflation to 5%.

Methods A two-stage modelling process was used. First, a non-linear multivariate regression model was fitted to cross-sectional smoking data, creating longitudinal projections from 2015 to 2035. Second, these projections were used to predict the future incidence, prevalence and cost of 17 smoking-related diseases using a Monte Carlo microsimulation approach. A sustained increase in the duty escalator was evaluated against a baseline of continuing historical smoking trends and the existing duty escalator.

Results A sustained increase in the TDE is projected to reduce adult smoking prevalence to 6% in 2035, from 10% in a baseline scenario. After increasing the TDE, only 65% of female and 60% of male would-be smokers would actually be smoking in 2035. The intervention is projected to avoid around 75 200 new cases of smoking-related diseases between 2015 and 2035. In 2035 alone, £49 m in National Health Service and social care costs and £192 m in societal premature mortality and morbidity costs are projected to be avoided.

Conclusion Increasing the UK TDE to 5% above inflation could effectively reduce smoking prevalence, prevent diseases and avoid healthcare costs. It would deliver substantial progress towards a tobacco-free society and should be implemented by the UK Government with urgency.

  • cessation
  • economics
  • end game
  • prevention
  • taxation

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  • Contributors All authors: involved in the design of the study. AKT, AJ, LR and MB: developed the model methodology, including development of algorithms and model assumptions. AKT, AB, AJ, LR and LW: provided information on the study methodology, data inputs and carried out the analysis of outputs. DH: wrote the introduction and discussion. AKT, DH, SH, LB and LW: contributed to manuscript revisions.

  • Funding This study was funded by Cancer Research UK (10.13039/501100000289).

  • Competing interests AKT and AB worked at the UK Health Forum when this research was under taken.

  • Patient consent Not obtained.

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