Peer-Reviewed Publications

      Estimating the population health impact of recently introduced Modified Risk Tobacco Products: A comparison of different approaches

      Lee, P. N.; Abrams, D.; Bachand, A.; Baker, G.; Black, R.; Camacho, O.; Curtin, G.; Djurdjevic, S.; Hill, A.; Mendez, D.; Muhammad-Kah, R. S.; Murillo, J. L.; Niaura, R.; Pithawalla, Y. B.; Poland, B.; Sulsky, S.; Wei, L.; Weitkunat, R.

      Published
      Jun 4, 2020
      DOI
      10.1093/ntr/ntaa102
      PMID
      32496514
      Link to publication
      Topic
      Summary

      Introduction: Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP).

      Aims and Methods: We aimed to compare and contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018.

      Results: Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the “null scenario” or joint smoking and MRTP habits in an “alternative scenario”. The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized.

      Conclusions: Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction.

      Implications: There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates.

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      Reduced Risk Products ("RRPs”) is the term we use to refer to products that present, are likely to present, or have the potential to present less risk of harm to smokers who switch to these products versus continuing smoking. PMI has a range of RRPs in various stages of development, scientific assessment and commercialization. All of our RRPs are smoke-free products that deliver nicotine with far lower quantities of harmful and potentially harmful constituents than found in cigarette smoke.