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Restricting tobacco sales to only pharmacies combined with cessation advice: a modelling study of the future smoking prevalence, health and cost impacts
  1. Frederieke S Petrović-van der Deen1,
  2. Tony Blakely1,2,
  3. Giorgi Kvizhinadze1,
  4. Christine L Cleghorn1,
  5. Linda J Cobiac1,
  6. Nick Wilson1
  1. 1 Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand
  2. 2 Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Frederieke S Petrović-van der Deen, Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington 6242, New Zealand; frederieke.petrovic-vanderdeen{at}


Objective Restricting tobacco sales to pharmacies only, including the provision of cessation advice, has been suggested as a potential measure to hasten progress towards the tobacco endgame. We aimed to quantify the impacts of this hypothetical intervention package on future smoking prevalence, population health and health system costs for a country with an endgame goal: New Zealand (NZ).

Methods We used two peer-reviewed simulation models: 1) a dynamic population forecasting model for smoking prevalence and 2) a closed cohort multi-state life-table model for future health gains and costs by sex, age and ethnicity. Greater costs due to increased travel distances to purchase tobacco were treated as an increase in the price of tobacco. Annual cessation rates were multiplied with the effect size for brief opportunistic cessation advice on sustained smoking abstinence.

Results The intervention package was associated with a reduction in future smoking prevalence, such that by 2025 prevalence was 17.3%/6.8% for Māori (Indigenous)/non-Māori compared to 20.5%/8.1% projected under no intervention. The measure was furthermore estimated to accrue 41 700 discounted quality-adjusted life-years (QALYs) (95% uncertainty interval (UI): 33 500 to 51 600) over the remainder of the 2011 NZ population’s lives. Of these QALYs gained, 74% were due to the provision of cessation advice over and above the limiting of sales to pharmacies.

Conclusions This work provides modelling-level evidence that the package of restricting tobacco sales to only pharmacies combined with cessation advice in these settings can accelerate progress towards the tobacco endgame, and achieve large population health benefits and cost-savings.

  • end game
  • cessation
  • economics
  • health services

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  • Contributors FSP-vdD led the writing, intervention specification, adaptation of the established models, analyses and extraction and interpretation of the results. All authors provided advice during analyses, and contributed towards the interpretation of results and drafting of the paper. All authors approved the final manuscript.

  • Funding FSP-vdD was supported by a University of Otago Doctoral Postgraduate Publishing Bursary. CLC, GK, LJC, TB and NW were supported by the BODE3 Programme, which is studying the effectiveness and cost-effectiveness of various health sector interventions and receives funding support from the Health Research Council of New Zealand (Grant numbers 10/248 and 16/443).

  • Competing interests None declared.

  • Patient consent Not required.

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