Increasing excise taxes on cigarettes in California: a dynamic simulation of health and economic impacts.

BACKGROUND California raised cigarette excise taxes in 1999, and may generate additional health and economic benefits by raising them further. METHODS A dynamic computer simulation model follows births, deaths, migration, aging, and changes in smoking status for the entire population of California over 75 years to estimate the cumulative health and economic outcomes of these changes under several excise tax rate conditions (up to 100% price increase). RESULTS A 20% tax-induced cigarette price increase would reduce smoking prevalence from 17% to 11.6% with large gains in cumulative life years (14 million) and QALY's (16 million) over 75 years. Total spending on cigarettes by consumers would increase by 270 million dollars in that span (all going to tax revenue), and those who reduce the number of years spent as a smoker would spend 12.5 billion dollars less on cigarettes. Total smoking-related medical costs would drop by 188 billion dollars. These benefits increase greatly with larger tax increases, with which tax revenues continue to rise even as smoking prevalence falls. CONCLUSIONS Even considering benefits from the 1999 increase, California has not yet maximized the potential of excise taxes to lessen the negative impacts of smoking. Additional tax increases would provide added health benefits and revenue to the state.

[1]  Sajjad Ahmad,et al.  The AMA proposal to mandate nicotine reduction in cigarettes: a simulation of the population health impacts. , 2005, Preventive medicine.

[2]  R. Kaplan,et al.  Simulated effect of tobacco tax variation on population health in California. , 2001, American Journal of Public Health.

[3]  J. Harris,et al.  The continuum-of-addiction: cigarette smoking in relation to price among Americans aged 15-29. , 1999, Health economics.

[4]  T. Hodgson,et al.  Cigarette smoking and lifetime medical expenditures. , 1992, The Milbank quarterly.

[5]  D. Remler.  Poor smokers, poor quitters, and cigarette tax regressivity. , 2004, American journal of public health.

[6]  Sajjad Ahmad.  The Cost-Effectiveness of Raising the Legal Smoking Age in California , 2005, Medical decision making : an international journal of the Society for Medical Decision Making.

[7]  P. Young,et al.  Time series analysis, forecasting and control , 1972, IEEE Transactions on Automatic Control.

[8]  H. Wechsler,et al.  Price, Tobacco Control Policies and Smoking Among Young Adults , 1995, Journal of health economics.

[9]  M. Gold.  Cost-effectiveness in health and medicine , 2016 .

[10]  George E. P. Box,et al.  Time Series Analysis: Forecasting and Control , 1977 .

[11]  J. Koplan,et al.  Preventing tobacco use among young people. A report of the Surgeon General. Executive summary. , 1994, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[12]  Patrick Fleenor.  How Excise Tax Differentials Affect Interstate Smuggling and Cross-Border Sales of Cigarettes in the United States , 2002 .

[13]  Anindya Sen,et al.  Estimating Price Elasticities When There is Smuggling: The Sensitivity of Smoking to Price in Canada , 2002, Journal of health economics.

[14]  Sajjad Ahmad,et al.  Federal policy mandating safer cigarettes: a hypothetical simulation of the anticipated population health gains or losses. , 2004, Journal of policy analysis and management : [the journal of the Association for Public Policy Analysis and Management].

[15]  P. Erickson,et al.  Years of healthy life. , 1995, Healthy People 2000 statistical notes.

[16]  D. Coate,et al.  The Potential for Using Excise Taxes to Reduce Smoking , 1981, Journal of health economics.

[17]  Gwilym M. Jenkins,et al.  Time series analysis, forecasting and control , 1972 .

[18]  M. Farrelly,et al.  State Cigarette Excise Taxes: Implications for Revenue and Tax Evasion , 2003 .