Using the NZ Smokefree goal for 2025 as a case study, these researchers modelled the impacts on smoking prevalence, health gains (quality-adjusted life-years [QALYs]) and cost savings of (1) 10% annual tobacco tax increases, (2) a tobacco-free generation, (3) a substantial outlet reduction strategy, (4) a sinking lid on tobacco supply and (5) a combination of 1, 2 and 3. The analysis included two models: (1) a dynamic population forecasting model for smoking prevalence and (2) a closed cohort (population alive in 2011) multistate life table model (including 16 tobacco-related diseases) for health gains and costs. All selected tobacco endgame strategies were associated with reductions in smoking prevalence by 2025, down from 34.7%/14.1% for Māori/non-Māori in 2011 to 16.0%/6.8% for tax increases; 11.2%/5.6% for the tobaccofree generation; 17.8%/7.3% for the outlet reduction; 0% for the sinking lid; and 9.3%/4.8% for the combined strategy. Major health gains accrued over the remainder of the 2011 population’s lives ranged from 28,900 QALYs (95% Uncertainty Interval [UI] 16,500 to 48,200; outlet reduction) to 282,000 QALYs (95% UI 189,000 to 405,000; sinking lid) compared with business-as-usual (3% discounting). The timing of health gain and cost savings greatly differed for the various strategies (with accumulated health gain peaking in 2040 for the sinking lid and 2070 for the tobacco-free generation).
