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Effect of IQOS introduction on cigarette sales: evidence of decline and replacement
  1. Michal Stoklosa1,
  2. Zachary Cahn1,
  3. Alex Liber1,
  4. Nigar Nargis2,
  5. Jeffrey Drope1
  1. 1 Economic and Health Policy Research, American Cancer Society, Atlanta, Georgia, USA
  2. 2 Economic and Health Policy Research, American Cancer Society, Washington, District of Columbia, USA
  1. Correspondence to Michal Stoklosa, Economic and Health Policy Research, American Cancer Society, Atlanta, GA 30310, USA; michal.stoklosa{at}


Background Philip Morris International, one of the largest transnational cigarette manufacturers, has heavily invested in its new heated tobacco product, IQOS, marketing it aggressively as a less harmful alternative to cigarette smoking. The company’s assertions that the product replaces cigarettes in a market have never been independently tested. The objective of this study is to determine whether introduction of IQOS affected cigarette sales in a large economy.

Data and Methods Using 2014 to 2018 monthly retailer panel data from Japan, we analyse whether different dates of IQOS introduction across Japan’s regions are reflected in the patterns of cigarette sales in those regions. A series of placebo models are estimated to test if events other than IQOS introduction could have better explained the observed trends in cigarette sales.

Results Cigarette sales begin to substantially decline at the time of the introduction of IQOS in each of 11 Japanese regions (Chow tests p<0.001). IQOS introduction, which varied across regions, better predicted the timing of cigarette sales decline than any one time applied to all regions simultaneously (a national-level exogenous shock) and than nearly all possible rearrangements of the true IQOS introduction months among the regions (exact permutation test’s p value from 0.02 to 0.13, depending on the study approach).

Conclusions The introduction of IQOS likely reduced cigarette sales in Japan. The net population health impact, however, cannot be assessed without resolving several key uncertainties related to the direct harms of IQOS and the precise patterns of both smoking and IQOS use.

  • electronic nicotine delivery devices
  • economics
  • global health
  • heated tobacco products

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  • Contributors MS and ZC designed the study. MS conducted the analysis. MS and ZC wrote the first draft of the manuscript. All authors contributed to interpretation of results and to refinement, writing and editing of the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The contents of this article are the sole responsibility of the authors and do not necessarily represent the positions of the American Cancer Society.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement For proprietary reasons, the data used in this manuscript cannot be

    made available to all potential users.