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Health impact assessment to predict the impact of tobacco price increases on COPD burden in Italy, England and Sweden

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Elaine Fuertes, Alessandro Marcon, Laura Potts, Giancarlo Pesce, Stefan K. Lhachimi, Virjal Jani, Lucia Calciano, Alex Adamson, Jennifer K. Quint, Debbie Jarvis, Christer Janson, Simone Accordini, Cosetta Minelli

Original languageEnglish
Article number2311
JournalScientific Reports
Issue number1
PublishedDec 2021

Bibliographical note

Funding Information: This work was supported by the Ageing Lungs in European Cohorts (ALEC) study (, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 633212. The funding source was not involved in the study design, in the collection, analysis and interpretation of data, the writing of the report and in the decision to submit the article for publication. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Raising tobacco prices effectively reduces smoking, the main risk factor for chronic obstructive pulmonary disease (COPD). Using the Health Impact Assessment tool “DYNAMO-HIA”, this study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices, with larger increases considered in secondary analyses. A dynamic Markov-based multi-state simulation modelling approach estimated the effect of changes in smoking prevalence states and probabilities of transitioning between smoking states on future smoking prevalence, COPD burden and life expectancy in each country. Data inputs included demographics, smoking prevalences and behaviour and COPD burden from national data resources, large observational cohorts and datasets within DYNAMO-HIA. In the 20% price increase scenario, the cumulative number of COPD incident cases saved over 40 years was 479,059 and 479,302 in Italy and England (populous countries with higher smoking prevalences) and 83,694 in Sweden (smaller country with lower smoking prevalence). Gains in overall life expectancy ranged from 0.25 to 0.45 years for a 20 year-old. Increasing tobacco prices would reduce COPD burden and increase life expectancy through smoking behavior changes, with modest but important public health benefits observed in all three countries.

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