Tobacco harm reduction directly saves lives. But by reducing smoking-related diseases, it also has the potential to free up precious health care resources for reallocation to other pressing concerns.
What kind of scale are we talking about? That’s where an economist could help us.
Francesco Moscone is a professor of business economics at Brunel University in the United Kingdom, and professor of public finance at Ca’ Foscari University of Venice, Italy. His latest study, published in the British Journal of Healthcare Management, investigates the savings the UK’s National Health Service (NHS) could make if more people switch from smoking to safer nicotine options like vapes.
Smoking kills about 76,000 people each year in the UK. And more than half a million annual hospital visits per year are attributed to smoking-related conditions. This costs the NHS an estimated £2.5 billion a year.
I spoke with Professor Moscone to find out how tobacco harm reduction could change that picture. Our interview has been edited for length and clarity.
“In a more optimistic scenario, where 50 percent of smokers made this transition, [I projected] a 13 percent decrease in hospital admissions.”
Kiran Sidhu: What were the headline findings of your study?
Francesco Moscone: If 10 percent of smokers were to switch to reduced-risk products, with a presumed 70 percent reduction in the risk of smoking-related diseases, the overall population would see a 2.6 percent decrease in total hospital admissions and a 2.5 percent reduction in health expenditure for various illnesses. This would result in annual savings exceeding £103 million.
In a more optimistic scenario, where 50 percent of smokers made this transition, [I projected] a 13.0 percent decrease in hospital admissions and a 12.36 percent reduction in health expenditure across the five disease categories—lung cancer, oral cancer, chronic obstructive pulmonary disease [CPOD], cerebrovascular heart disease and ischaemic heart disease—considered in this study. This would lead to impressive annual savings of £518 million.
Can you briefly explain your process for arriving at these figures?
Employing official data sources such as the Office for National Statistics, and guided by assumptions grounded in clinical evidence, I undertook an exploratory data analysis of smoking behaviors. This encompassed an in-depth examination of both demand and supply patterns, taking into account diverse regions within England.
I then simulated different estimated savings in the health system where the smoking population shifted to innovative alternative products, such as e-cigarettes and “heat-not-burn” tobacco.
When I embarked on this study, I anticipated that we would witness savings … If those alternative products are better, as research suggests, then an economic gain seems logical. The primary rationale behind this expectation is that, thus far, these products seem to entail a significantly lower risk of developing various types of cancers compared to smoking. This translates to fewer hospital admissions, reduced treatments and lower expenditures.
“Ultimately, what truly counts, regardless of the type of health care system, is the nation’s ability to reduce avoidable mortalities.”
How would you describe why your study was needed?
While there is extensive clinical evidence detailing the adverse effects of smoking, and a mounting body of research supporting the clinical efficacy of reduced-risk products, there remains a notable gap in the understanding [these products’] cost-effectiveness in the health care sector. This study seeks to address this gap, representing one of the pioneering efforts in this regard.
Essentially, transitioning to reduced-risk products has the potential to free up additional public resources, especially vital in times of profound economic turmoil, which can be redirected towards urgent concerns, such as addressing escalating [NHS] wait times.
Your study concerned the UK, but how might your findings translate to other countries?
This study can certainly be replicated in other countries striving to conserve public resources—including those with a national health service like Italy, or more broadly, countries with significant public health care systems, like Medicare in the United States.
It’s worth noting that, unsurprisingly, these low-cost interventions can also be influenced by market dynamics and can be applied in private health care systems.
Ultimately, what truly counts, regardless of the type of health care system, is the nation’s ability to reduce avoidable mortalities.
The impact of smoking on [health care systems] is huge. Globally, the economic cost of smoking is considered to be around $1.85 trillion. It is of such magnitude in terms of health expenditure that governments are contemplating a ban on smoking. The point, however, is to focus on methods that can produce real effects on reality. We will not solve this epidemic via slogans, unfortunately. We need practical solutions. I believe in incremental gains.
“Do not limit the offer of better alternatives available to adult smokers.”
How important is tobacco harm reduction in helping the UK reach its 2030 “smoke-free” goal?
The significance of innovative reduced-risk products in achieving this goal cannot be overstated.
Official statistics reveal a decline in smoking prevalence among adults in England, dropping from 13.9 percent in 2019 to 13.0 percent in 2021, continuing a downward trend observed since 2011. This reduction can be attributed, at least in part, to the increasing popularity of vapes and heat-not-burn products.
However, I concur with the charity Action on Smoking and Health in their observation that smoking rates nationwide are not decreasing rapidly enough to meet the government’s target of 5 percent or less by 2030. One potential solution could involve policymakers actively promoting a significant transition of the smoking population towards these alternative reduced-risk products, incentivizing the substitution of combusted products with all other reduced-risk products.
In other words, do not limit the offer of better alternatives available to adult smokers.
If UK’s 2030 goal is met, what would this mean for the NHS?
This would result in more resources becoming available for [other] critical health priorities. Nevertheless, I believe it’s important to also investigate changes in the consumption of other risk-inducing products, like excessive [alcohol] intake, high-fat diets and elevated sugar consumption during these years. This has the potential to save additional resources and, most importantly, more lives!
Will you be doing more research on the impacts of tobacco harm reduction?
I can give you a preview in this interview that I’ve been conducting another study focusing on examining potential savings through transitioning to reduced-risk products, moderate alcohol consumption and increased physical activity, using Italian data. I believe we’ll be able to collect more evidence from comparable countries, as both Italy and the UK have a national health service (Sistema Sanitario Nazionale).
Photograph courtesy of Prof. Moscone