Estimating the effect of differing assumptions on the population health impact of introducing a Reduced Risk Tobacco Product in the USA

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We use Population Health Impact Modelling to assess effects on tobacco prevalence and mortality of introducing a Reduced Risk Tobacco Product (RRP). Simulated samples start in 1990 with a US-representative smoking prevalence. Individual tobacco histories are updated annually until 2010 using estimated probabilities of switching between never/current/former smoking where the RRP is not introduced, with current users subdivided into cigarette/RRP/dual users where it is. RRP-related mortality reductions from lung cancer, IHD, stroke and COPD are derived from the histories and the assumed relative risks of the RRP.A basic analysis assumes a hypothetical RRP reduces effective dose 80% in users and 40% in dual users, with an uptake rate generating ˜10% RRP and ˜6% dual users among current users after 10 years. Sensitivity study changes in tobacco prevalence and mortality from varying effective doses, current smoking risks, quitting half-lives and rates of initiation, switching, re-initiation and cessation. They also study extreme situations (e.g. everyone using RRP), and investigate assumptions which might eliminate the RRP-related mortality reduction. The mortality reduction is proportional to the dose reduction, increasing rapidly with time of follow-up. Plausible increases in re-initiation or dual users’ consumption, or decreased quitting by smokers would not eliminate the drop.HIGHLIGHTSIn this journal, we previously described our Population Health Impact Model.Using it we assess effects of introducing a hypothetical lower risk tobacco product.It is assumed to be introduced in 1990 with mortality effects studied over 20 years.A basic set of assumptions is studied, as well as a range of sensitivity analyses.Major and minor factors affecting the reduction in deaths are determined.

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