The brunt of the economic and health burden of tobacco use, the leading preventable cause of death globally, is projected to tip towards low- and middle-income countries in the next decade.
Implications | The World Health Organization (WHO)/National Cancer Institute (NCI) report highlighted the health and economic consequences of tobacco use, particularly in low- and middle-income countries, and the need for smoking-cessation policies (including pharmacological therapies) to curb tobacco consumption. The report assumed the WHO will miss its target for a 30% relative reduction in tobacco use by 2025. Unless smoking prevalence rates are checked, this may result in higher oncology medicine expenditure than currently projected. |
Outlook | Tobacco-related mortality rates are forecast to rise in 2016–30, with the economic and healthcare burden increasingly shifting from high-income countries to low- and middle-income countries, according to the WHO/NCI analysis of smoking trends and prevalence rates. |
The World Health Organization (WHO) and US-based National Cancer Institute (NCI) published a joint report today (10 January), forecasting nearly a one-third increase in tobacco-related deaths globally from about 6 million annually at present to over 8 million annually by 2030. One of the highlights of the report for the pharmaceutical industry is the assertion that at least 80% of the increase in tobacco-related deaths will occur in low- and middle-income countries (LMICs).
A full version of the report is available to view here and here.
The report estimated that there are 1.1 billion smokers globally (aged 15 or older) or equivalent to 21% of the global population. Of these, about 80% live in LMIC regions, with about 226 million living in poverty and therefore presumably less abhicle to access healthcare or smoking-cessation drugs. The effect of tobacco in non-communicable disease (NCD) areas is a major contributing factor, and reducing tobacco use is central to the WHO goal of reducing premature deaths from NCDs by one-third annually by 2030. According to the WHO, a total of 12% of all adult deaths (aged 30 and older) are linked to tobacco use. Globally, 14% of all adult deaths from NCDs are attributed to tobacco use. This includes 10% of adult deaths from cardiovascular diseases and 22% from cancer. About 71% of adult lung-cancer deaths are tobacco-related. Furthermore, the WHO links 36% of all adult deaths from diseases of the respiratory system to tobacco use, and smoking is responsible for 75% of chronic obstructive pulmonary disease cases.
The study presented a detailed analysis of the economic costs of smoking borne by the global economy, including the healthcare cost of treating diseases and the productivity costs of death and disability. Unsurprisingly, the authors of the report concluded that external costs of tobacco use are greater in high income countries (HICs) where public funds are used to pay for a greater share of healthcare costs. In countries with underdeveloped health systems, the estimated economic costs of smoking vary more widely. This reflected the differences in the role that governments play in providing healthcare in LMICs. In further analysis, the WHO/NCI estimated that only USD269 million was collected in taxation on tobacco revenues globally during 2013–14. This pales in comparison with the estimated economic cost, which is likely to be "over USD1 trillion in healthcare costs and lost productivity" annually, according to the peer reviewed study.
The WHO/NCI strongly supports the adoption of greater tobacco-control policies at a national level, including using tobacco taxation to support "highly cost-effective demand-reducing interventions". This encompasses a combination of anti-smoking campaigns and support for cessation treatments. A number of HICs , such as Italy, are examining proposals for new taxes on tobacco products to fund innovative oncology medicines, for example (see Italy: 13 July 2016: Tobacco industry challenges proposed EUR720-mil. tax scheme for innovative drug purchases). These plans are still on the drawing board, but have been attacked by the tobacco industry on the grounds that they would have an adverse economic effect. This resistance is based on the suggestion that new taxes would push consumers towards cheaper tobacco brands that reduce the government's tax revenues. The WHO/NCI discounts this possibility and urges governments to consider adopting similar approaches. In the long term, this would be a positive development for the pharmaceutical sector because it offers the potential to allocate new funding sources to smoking-cessation and anti-cancer medicines.
The majority of countries underutilise prevention tools to reduce tobacco use, including smoking-cessation drugs, according to the WHO. Studies show deregulation of pharmacological therapies for smoking cessation increases demand for these products. However, the provision of smoking-cessation drugs is strongly dependent on the income status of a given country (see Denmark: 26 August 2016: Danish national cancer strategy boosts funding for smoking cessation drugs). Only 12% of 195 countries analysed by the WHO/NCI provided comprehensive tobacco-cessation services. The majority of these countries are in the HIC bracket, while only 23% of low-income countries covered the cost of nicotine replacement therapies (NRTs) or other cessation services.
Greater prioritisation given over to smoking-cessation medications that tackle tobacco dependence would require deregulation to enhance patient access to over-the-counter (OTC) drugs, and higher levels of financial support to patients for smoking-cessation medicines in middle-income countries. Cost remains a substantial barrier to the use pharmacological therapies in both LMICs and HICs. The demand for smoking-cessation treatment services is likely to be lower in LMICs than in HICs, given the higher price of cessation treatment relative to tobacco products. A cost-effectiveness analysis referred to by the WHO/NCI concluded that NRTs across low-, middle-, and high-income countries cost between USD358 and USD1,917 per disability-adjusted life year (DALY) saved. The cost per DALY was lower in LMICs at USD280 to USD870, compared with USD750 to USD7,206 in HICs. This provides an economic rationale for governments to intervene, and the WHO research implies that increasing limited availability and access to cost-effective tobacco-dependence treatments would be beneficial in LMICs. This potentially represents a sales opportunity. Among the beneficiaries in the pharmaceutical sector are likely to be Perrigo (US)'s NiQuitin and Nicotinell NRTs.
Outlook and implications
NCDs linked to tobacco use post large health risks to LMICs in particular. The WHO/NCI results show that tobacco consumption is set to increase as a major preventable risk factor in NCD deaths in these countries by 2030, unless checked. The analysis is designed to fill gaps in the data on the subject and should help to improve the preventative and health promotion policies adopted by a number of mainly LMICs in the years ahead. The report places a policy emphasis on preventative measures against tobacco dependence, including pharmacological therapies, which has the potential to increase sales of smoking-cessation medications. The analysis of the policy effect of control measures would potentially help to avert millions of smoking-related deaths globally, which are likely to reach 8 million annually based on the WHO research.