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Correspondence to Frederieke S van der Deen, Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE), University of Otago, 23 Mein Street, Newtown, Wellington 6242, New Zealand; [email protected]
Introduction
There is growing international interest in advancing the final stage of the tobacco pandemic, that is, ‘the tobacco endgame’.1 A number of countries—New Zealand, Sweden, Ireland and multiple Pacific Island Nations—aim to achieve their respective tobacco endgames by 2025. Some other jurisdictions have different end dates (eg, Denmark 2030, Scotland 2034, Finland 2040), or are exploring novel ways of accelerating progress towards reducing smoking without a specific target date. A recent case was made for the adoption of a global tobacco endgame goal for 2040—a world ‘where less than 5% of the adult population use tobacco’.2 While a number of countries have made significant progress in reducing smoking prevalence in recent decades, for the vast majority of countries achieving endgame goals most likely requires intensified beyond business-as-usual (BAU) action.2–4
A range of innovative strategies have been proposed to accelerate progress towards reducing smoking prevalence, and ultimately towards eliminating tobacco-related morbidity and mortality,1 5 but there has been little research estimating the impact of endgame strategies on future smoking prevalence, population health and health system costs. Quantifying these effects and the associated uncertainty could guide endgame decision making.
The aims of this study were to quantify the future prevalence, health and cost impacts of five tobacco endgame strategies using New Zealand as a case study. A continuation of past trends in smoking uptake and cessation (BAU) served as the comparator. The endgame strategies were ongoing annual tobacco tax increases (an established part of tobacco control in New Zealand since 2010), the tobacco-free generation (TFG) strategy6 (a ban on the provision of tobacco to those born from a set year onwards), a sinking lid on tobacco supply (involving regular reductions in the amount of tobacco supplied to the commercial market until supply ends),7 and a substantial reduction in the number of tobacco retail outlets given the observed association between increased tobacco retail outlet proximity and density with reduced cessation, and increased smoking uptake and relapse.8
We examined how time delays to health gains (and cost savings) differ between such strategies,...