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Impact of increasing tobacco taxes on working-age adults: short-term health gain, health equity and cost savings
  1. Christine L Cleghorn,
  2. Tony Blakely,
  3. Giorgi Kvizhinadze,
  4. Frederieke S van der Deen,
  5. Nhung Nghiem,
  6. Linda J Cobiac,
  7. Nick Wilson
  1. Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, University of Otago, Wellington, New Zealand
  1. Correspondence to Dr Christine L Cleghorn, Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, University of Otago, Wellington, Dunedin 9016, New Zealand; cristina.cleghorn{at}


Objective The 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.

Methods As 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%.

Results For 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.

Conclusions The 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.

  • economics
  • prevention
  • price
  • smoking-caused disease

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  • Contributors Conceived and designed the experiments: CLC, TB, GK, FSvdD, NN, LJC and NW. Analysed the data: CLC, TB, GK, FSvdD, NN, LJC and NW. Wrote the first draft of the manuscript: CLC, TB and NW. Contributed to the writing of the manuscript: CLC, TB, GK, FSvdD, NN, LJC and NW. Agree with the manuscript’s results and conclusions: CLC, TB, GK, FSvdD, NN, LJC and NW. All authors have read and confirm that they meet International Committee of Medical Journal Editors criteria for authorship.

  • Funding The authors are supported by the BODE3 Programme, which is studying the effectiveness and cost-effectiveness of various preventive interventions and receives funding support from the Health Research Council of New Zealand (project number 10/248).

  • Competing interests None declared.

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

  • Data sharing statement The authors can be contacted for additional data, and these will be provided pending agreement from the agency providing access to epidemiological and costing data (the New Zealand Ministry of Health).