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

Authored by  PN Lee*, JS Fry*, JF Hamling*, Z Sponsiello Wang, G Baker, R Weitkunat

Published in Regulatory Toxicology and Pharmacology     Volume 88, 192-213
* This author is not affiliated with PMI.


We use Population Health Impact Modelling to assess effects on tobacco prevalence and mortality of introducing a Reduced-Risk 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.