Beyond Life Years Lost, Using Different Outcomes for Population Modelling in Tobacco Harm Reduction

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Summary Evaluating the reduced-risk potential of novel tobacco and nicotine products, as compared to cigarettes, requires consideration not only of individual risk but also the impact on the population as a whole. Where the reduction in health risk for smokers who switch to the product instead of continuing to smoke, but also the product’s potential effects and rate of uptake among non-smokers must be taken into account. Computational models have proven to be a valuable tool to enable evaluation of long-term population health effects, in the absence of epidemiological data. Most population health models projecting the health impact of novel tobacco and nicotine products have primarily focussed on potential population harm or benefit using premature ‘all cause’ mortality rates attributable to cigarette smoking as the key output indicator. This study expands on previous mortality projections for the introduction of tobacco heated products (THPs) in Japan, using an enhanced systems dynamics model including non-mortality outcomes. This enables investigation of additional projections for person-years lived with disabilities, tobacco related disease incidence, tobacco use prevalence and tobacco user behaviour, such as average smoker age, the number of years smoked and the age at which individuals ceased smoking. Disease specific projections are provided for the main smoking related diseases, lung cancer, CVD and COPD, and also for esophageal cancer and lower extremity peripheral arterial disease as examples of the potential wider application of this modelling approach. Modelling estimates based on the available data, indicate that the introduction of THPs into the Japanese marketplace will reduce future smoking prevalence, smoking-related premature deaths and the burden of smoking related disabilities, compared to a scenario where THPs had not been introduced. The resulting projections demonstrate the ability to investigate population health impacts beyond all-cause mortality to provide further insight into the harm reduction potential of alternative nicotine products such as THPs.