Estimated Public Health Gains From German Smokers Switching to Reduced-Risk Alternatives: Results From Population Health Impact Modelling

Period (years)		Initiation (P_NC)		Quitting (P_CF)		Re-initiation (P_FC)
Period (years)	Age	Men	Women	Men	Women	Men	Women
1–5	10–14	50,351	40,762	28,960	17,309	13,903	8,308
	15–19	67,051	77,814	46,165	82,605	22,164	39,653
	20–24	8,903	35,760	16,045	58,582	7,701	28,119
	25–29	6,699	8,653	24,172	37,175	11,602	17,840
	30–34	2,637	4,288	30,186	30,128	14,495	14,459
	35–39	0	0	26,610	9,641	12,765	4,634
	40–44	0	0	23,808	18,902	11,424	3,080
45–49	0	0	27,218	19,232	9,796	1,559
50–54	0	0	36,677	25,626	5,291	1,032
55–59	0	0	40,739	33,146	2,912	684
60–64	0	0	40,265	40,970	1,427	420
65–69	0	0	55,101	26,610	960	264
70–74	0	0	90,546	223,260	684	192
75–79	0	0	90,546	223,260	684	192
6–10	10–14	42,977	35,249	24,477	26,200	11,756	12,575
	15–19	63,577	60,793	57,559	83,602	27,628	40,127
	20–24	6,174	23,515	11,626	60,079	5,578	28,832
	25–29	14,672	11,436	38,461	51,426	18,454	24,676
	30–34	3,953	5,649	35,122	29,264	16,860	14,045
	35–39	0	0	22,246	10,770	10,675	5,172
	40–44	0	0	20,917	25,907	9,558	3,104
45–49	0	0	27,066	27,745	7,200	1,667
50–54	0	0	43,070	31,795	5,172	960
55–59	0	0	48,060	32,086	2,888	684
60–64	0	0	46,430	39,282	2,529	420
65–69	0	0	67,962	47,417	1,858	252
70–74	0	0	55,785	177,670	1,367	180
75–79	0	0	55,785	177,670	1,367	180
11+	10–14	34,053	24,583	21,858	42,274	10,497	20,281
	15–19	64,469	54,133	72,396	106,963	34,750	51,335
	20–24	3,869	9,165	6,914	53,403	3,319	25,626
	25–29	22,974	13,772	57,718	70,086	27,698	33,646
	30–34	5,948	6,783	42,366	24,888	20,328	11,946
	35–39	0	0	17,321	11,079	8,308	5,315
	40–44	0	0	18,489	36,711	7,152	4,407
45–49	0	0	30,676	35,749	4,574	2,792
50–54	0	0	49,103	35,458	3,678	2,170
55–59	0	0	54,714	28,960	2,050	1,655
60–64	0	0	51,438	32,040	1,954	876
65–69	0	0	87,902	27,523	1,631	492
70–74	0	0	18,737	63,915	432	372
75–79	0	0	18,737	63,915	684	192

[i] The first period relates to 5 years starting from 1995, the second to 5 years starting from 2000, and the third to 10 years starting from 2005. The transition probabilities between the three states N (never), C (current), and F (former) are described by P followed by two subscripts, the first representing the state changed from and the second the state changed to.

[ii] Note that RRPs are not introduced in the Null Scenario.

Table 2

The Alternative Scenarios.

Scenario Number	Name	Summary description and comments
Extreme Scenarios
1	Complete cessation	In 1995, all current cigarette smokers immediately stop smoking. There is no further initiation or re-initiation of cigarettes, HnB, or ECig use.
2	Complete switch to RRPs (HnBs)	In 1995, all current cigarette smokers immediately switch to HnBs. The subsequent initiation, re-initiation, and quitting rates are as in the Null Scenario, but only involve transfers in or out of HnBs.
3	Complete switch to RRPs (50% HnBs and 50% ECigs)	In 1995, all current cigarette smokers immediately switch to either HnBs or ECigs with equal probability. The subsequent rates are as in the Null Scenario, but only involve transfers involving the new products.
Pragmatic Scenarios
		HnB: The market share in 2005 is 9% of that in 1995 for cigarette smoking, with 67% exclusive users. ECig: The market share in 2005 is 27% of that in 1995 for cigarette smoking, with 40% exclusive users. The calculated target distributions for 2005 are:
			Never	Cig only	HnB only	ECig only	Multiple use	Former use
4	Conservative Scenario	Men	35.46	24.22	2.28	4.09	7.25	26.70
		Women	60.56	15.64	1.47	2.64	4.68	15.01
		Note: Multiple (product) users currently use at least one of the three products, while former (product) users have used at least one of the products, but do not currently use an).
		The sum of the TPs for initiation and the sum of the TPs for re-initiation are the same as that for the Null Scenario. Each quitting TP is as for the Null Scenario. The difference between the four Pragmatic Scenarios only relates to the rates of switching among the three products.
		The market shares in 2005 increase to 15.5% for HnBs and 36.4% for ECigs. The proportions of exclusive users are as in the Conservative Scenario. The calculated target distributions for 2005 are:
			Never	Cig only	HnB only	ECig only	Multiple use	Former use
5	Dynamic Scenario	Men	35.46	18.20	3.93	5.51	10.20	26.70
		Women	60.56	11.75	2.54	3.56	6.59	15.01
		The rates of switching from exclusive cigarette smoking are increased from those in the Conservative Scenario.
		The same as the Dynamic Scenario, except that the proportions of exclusive users rise to 84% for both RRPs. The calculated target distributions for 2005 are:
6	Conversion Scenario		Never	Cig only	HnB only	ECig only	Multiple use	Former use
		Men	35.46	18.20	4.93	11.57	3.14	26.70
		Women	60.56	11.75	3.18	7.47	2.03	15.01
		Relative to the Dynamic Scenario, all 12 possible rates of switching vary, except those of switching from exclusive use of one RRP to exclusive use of the other.
		The same as the Dynamic Scenario, except that the proportions of exclusive users rise to 100% for both RRPs. The calculated target distributions for 2005 are:
7	Full Conversion Scenario	Men	35.46	18.20	5.87	13.87	0.00	26.70
		Women	60.56	11.75	3.79	8.89	0.00	15.01
		The comment for the Conversion Scenario applies here as well.

[i] Abbreviations used: Cig = cigarette; ECig = e-cigarette; HnB =heat-not-burn; TP = transition probability;

Table 3

Assumed relative risk for continued smoking and quitting half-life by disease for Germany.

	Age (years)	LC	COPD	Stroke	IHD
Relative risk	Any	8.68	3.31	–	–
	to 54	–	–	2.48	3.38
	55–64	–	–	2.13	2.32
	65–74	–	–	1.39	1.70
	75–79	–	–	1.06	1.27
Half-life	Any	–	13.32	4.78	–
	to 49	6.98	–	–	1.47
	50–59	10.39	–	–	5.22
	60–69	10.60	–	–	7.48
	70–79	12.99	–	–	13.77

[i] See (27) for the sources of these estimates.

Comparison of Null Scenario and derived estimates of current smoker prevalence.

**Product usage in the Conversion Scenario.** Abbreviations used: ECig = e-cigarettes; HnB = heat-not-burn;

Table 4

Drop in deaths in Germany over the whole follow-up period for the seven Alternative Scenarios.

		Drop in deaths					% Drop in deaths
	Sex/Scenario	LC	IHD	Stroke	COPD	All four diseases	LC	IHD	Stroke	COPD	All four diseases
Men
1	Complete cessation	48,092	83,798	15,429	14,166	161,485	13.38	45.26	46.06	16.48	24.32
2	Complete switch to RRPs (HnBs)	34,148	61,591	11,783	10,820	118,342	9.50	33.27	35.17	12.59	17.82
3	Complete switch to RRPs (50% HnBs; 50% ECigs)	38,967	69,431	13,111	12,038	133,547	10.84	37.50	39.14	14.01	20.11
4	Conservative Scenario	8,316	16,144	3,286	2,969	30,714	2.31	8.72	9.81	3.46	4.63
5	Dynamic Scenario	13,437	25,533	5,136	4,680	48,785	3.74	13.79	15.33	5.44	7.35
6	Conversion Scenario	15,950	30,276	6,004	5,425	57,655	4.44	16.35	17.92	6.31	8.68
7	Full Conversion Scenario	17,210	32,734	6,431	5,777	62,153	4.79	17.68	19.20	6.72	9.36
Women
1	Complete cessation	23,231	18,101	7,345	6,487	55,165	22.01	45.20	50.02	23.22	29.31
2	Complete switch to RRPs (HnBs)	16,617	13,670	5,649	5,000	40,936	15.74	34.14	38.47	17.89	21.75
3	Complete switch to RRPs (50% HnBs; 50% ECigs)	18,882	15,245	6,261	5,534	45,923	17.89	38.07	42.64	19.81	24.40
4	Conservative Scenario	3,476	3,089	1,369	1,169	9,104	3.29	7.71	9.32	4.19	4.84
5	Dynamic Scenario	5,605	4,934	2,141	1,859	14,540	5.31	12.32	14.58	6.66	7.72
6	Conversion Scenario	7,014	6,035	2,616	2,277	17,942	6.64	15.07	17.81	8.15	9.53
7	Full Conversion Scenario	7,530	6,404	2,783	2,424	19,140	7.13	15.99	18.95	8.67	10.17

[i] Abbreviations used: COPD = chronic obstructive pulmonary disease, ECig = e-cigarette, HnB = heat-not-burn, IHD = ischaemic heart disease, LC = lung cancer;

**DDs in the Conversion Scenario over the whole follow-up period.** Abbreviations used: COPD = chronic obstructive pulmonary disease; IHD = ischaemic heart disease; LC = lung cancer;

Table 5

Years of life saved (thousands) by age 75 over the whole follow-up period in Germany.

		Men					Women
	Scenario	LC	IHD	Stroke	COPD	All four diseases	LC	IHD	Stroke	COPD	All four diseases
1	Complete cessation	520	1,329	213	98	2,160	292	258	118	52	720
2	Complete switch to RRPs (HnBs)	357	943	160	74	1,534	203	189	89	40	521
3	Complete switch to RRPs (50% HnBs; 50% ECigs)	412	1,077	180	83	1,752	233	213	99	44	589
4	Conservative Scenario	83	241	43	20	387	42	43	21	10	116
5	Dynamic Scenario	134	379	68	31	612	67	68	33	15	183
6	Conversion Scenario	161	461	80	37	739	84	84	40	18	226
7	Full Conversion Scenario	176	506	86	39	807	90	89	43	19	241

[i] Abbreviations used: COPD = chronic obstructive pulmonary disease; ECig = e-cigarette; HnB = heat-not-burn; IHD = ischaemic heart disease; LC = lung cancer; RRP = reduced risk product;

**YLS by Scenario over the whole follow-up period.**
See Table 2 for a description of the scenarios.

Articles in this issue

DOI: https://doi.org/10.2478/cttr-2022-0004 | Journal eISSN: 2719-9509 (formerly 1612-9237)

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Language: English, French, German

Page range: 35 - 51

Submitted on: May 27, 2021

Accepted on: Mar 1, 2022

Published on: May 5, 2022

Published by: Beiträge zur Tabakforschung GmbH

In partnership with: Paradigm Publishing Services

Keywords:

Smoking,

public health,

modelling,

lung cancer,

chronic obstructive pulmonary disease,

ischaemic heart disease,

stroke,

e-cigarettes,

heat-not-burn product,

Germany

Related subjects:

Life sciences,

Life sciences, other

© 2022 Romana Rytsar, Smilja Djurdjevic, Alexander K. Nussbaum, Ashok Kaul, Emanuel Bennewitz, Peter N. Lee, John S. Fry, published by Beiträge zur Tabakforschung GmbH
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License.

Volume 31 (2022): Issue 1 (March 2022)

Estimated Public Health Gains From German Smokers Switching to Reduced-Risk Alternatives: Results From Population Health Impact Modelling

Figures & Tables

Table 1

Table 2

Table 3

Figure 1

Figure 2

Table 4

Figure 3

Table 5

Figure 4

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