Anti-smoking measures implemented in France since 2016 are effective

A French study[1] published by researchers from the Organisation for Economic Co-operation and Development (OECD) and Santé Publique France in the journal Tobacco Control shows that, over the period 2023-2050 and compared to a scenario without any action, the anti-smoking measures implemented in France since 2016 should make it possible to avoid around 4.03 million cases of chronic diseases linked to smoking, save €578 million per year in health expenditure, and increase employment and productivity by the equivalent of 19,800 additional full-time workers per year.

This study was conducted using the OECD Micro Simulation Model for Public Health Strategic Planning for Noncommunicable Diseases. The model was informed by historical and projected trends in smoking prevalence as captured by the Action Programme.

Comprehensive measures that have helped reduce smoking prevalence

Smoking prevalence in France remains high compared to other high-income countries, with 32,133 adults smoking in 2021, and 25,133 daily smokers. France launched its first National Tobacco Reduction Program in 2014, followed by a National Tobacco Control Program in 2018, with a set of measures implemented between 2016 and 2019 based on four main pillars: (1) a gradual increase over three years in taxes on tobacco products, i.e. a 41,133 increase in the price of the most sold cigarette packs; (2) plain packaging of tobacco products was made mandatory for packs put on sale from 1 January 2017 (with enlarged health warnings); (3) reimbursement by Health Insurance of nicotine substitutes (SN) at 65 % since January 1, 2019, and (4) the organization from 2016 of an annual social marketing campaign promoting smoking cessation “No Tobacco Month” in November.

During the implementation of these four measures, between 2016 and 2019, smoking prevalence decreased from 35 % to 31 % and quit attempts among daily smokers increased from 25 % to 33 %, while SN sales increased by 28 % between 2019 and 2020.

Millions of smoking-related chronic diseases prevented

The results suggest that implementing these measures is likely, in cumulative numbers from 2023 to 2050, to avert approximately 4.03 million cases of noncommunicable diseases (2.09 according to the low estimates to 11.84 million according to the high estimates), namely: 1.87 million cases of musculoskeletal disorders, 1.54 million cases of lower respiratory infections, 275,000 cases of COPD, 170,000 cases of cancer, 104,000 cases of cardiovascular diseases, 40,000 cases of dementia and 32,000 cases of diabetes.

This anti-smoking policy should make it possible, by 2050, to increase the number of life years (LY) for the French population by 644,000 years (436,000 to 2,168,000) and healthy life years (HLY) by 1,040,000 (636,000 to 3,389,000) for the French population, which corresponds to 62 LY (41 to 206) and 99 HLY (60 to 318) per 100,000 inhabitants gained each year.

These measures are expected to reduce health expenditure by €578 million (€365 million to €1,848 million) per year over the period 2023-2050, or approximately €8.7 (€5.5 million to €27.8 million) per capita per year, or 0.32 % (€0.20 million to €1.02%) of total health expenditure. By 2050, all of these tobacco control measures could save up to €143 (€91 million to €466 million) per capita in health expenditure.

A long-term cost-effective policy

The savings achieved correspond to a return on investment of €4 (€2.5–€12.5) for every € invested in the programme, whose total cost of the measures, which was estimated at €148 million per year, includes the costs of implementing the tax increase, the No Tobacco Month campaign and the reimbursement of SNs. The cost of implementing tobacco plain packaging is considered negligible for the government, as it is mainly borne by the industry. Revenues from increased taxation were not included in the analysis, in line with the WHO CHOICE (CHOosing Interventions that are Cost-Effective) approach to taxation analyses.

According to the authors, the reduction in the incidence of tobacco-related diseases allows more individuals to actively engage in the labor market and be more productive if they have a job. Also, it is estimated that the anti-smoking policy will increase employment and productivity by the equivalent of 19,800 full-time equivalent workers per year, mainly through increased employment and reduced absenteeism.

Anti-smoking policies are generally cost-effective

Two recent studies have assessed the return on investment of tobacco control policies in Canada and Florida (USA). In Canada, for every Canadian $ invested in tobacco control between 2001 and 2016, 19.8 $ were returned in health care costs, productivity and life-year gains, and tax revenues. For health care savings alone, the return on investment is estimated at 8 $ for every $ invested. In the US study, for every $ invested in the tobacco control program in Florida between 1999 and 2015, 10 $ were saved in health care.

The observation in France of a return on investment (4/1) lower than that of the North American studies can be explained, at least in part, by the fact that the French simulation model takes into account the health costs of people who do not smoke/no longer smoke as a result of the measures taken, but who may subsequently develop chronic diseases unrelated to smoking and, as a result, incur the resulting health costs.

©Generation Without Tobacco

AE