Publication

Abstract : Introduction Tobacco use is a major global health risk, causing over eight million deaths annually. The World Health Organization Framework Convention on Tobacco Control requires member countries to adopt a raft of comprehensive policy measures, including taxation. In India, 28% of adults consume tobacco, with a high prevalence of both combustible and smokeless forms, contributing to a substantial health burden. To inform tobacco tax policy in India, we estimated the potential impact of taxation on lowering the prevalence of use and the associated health and economic burden. Methods We employed a Markov probabilistic microsimulation to simulate the impact of increasing tobacco taxes on tobacco-related diseases, healthcare costs, productivity losses, and quality of life over a lifetime horizon. Results Combustible tobacco use in India is responsible for ~922 000 deaths and 8.9 million disease events annually. Smokeless tobacco (SLT) contributes to 165 000 deaths and 400 000 disease events. The economic burden of direct and indirect costs is substantial: INR 3.56 trillion for combustible tobacco and INR 358 billion for SLT. Increasing tobacco taxes by 50% could avert 1.8 million deaths (~9.8% of tobacco-attributable deaths over 10 years), 66.8 million healthy life-years lost, and provide economic benefits exceeding INR 11.9 trillion over 10 years. Conclusions Tobacco use remains a major health and economic burden in India. Both combustible and SLT cause high mortality and morbidity. Taxation emerges as a potentially effective tool to reduce deaths, life years lost, and economic losses, with economic benefits reported exclusive of additional tax revenue. Implications Our study adds to the existing body of evidence by providing a detailed, India-specific analysis that distinguishes between the health and economic impacts of combustible versus smokeless tobacco. We estimated the disease burden and economic costs attributable to each form of tobacco and projected the potential benefits of increased tobacco taxation. Our findings show that a 50% increase in tobacco taxes could prevent 1.8 million deaths and save nearly INR 11.9 trillion over 10 years. This study uniquely quantifies the differential impacts of various tobacco products and offers robust evidence to support targeted tobacco control policies.