Peter N Lee1, David Abrams2, Annette Bachand3, Gizelle Baker4, Ryan Black5, Oscar Camacho6, Geoffrey Curtin7, Smilja Djurdjevic4, Andrew Hill8, David Mendez9, Raheema S Muhammad-Kah5, Jose Luis Murillo5, Raymond Niaura2, Yezdi B Pithawalla5, Bill Poland10, Sandra Sulsky3, Lai Wei5, Rolf Weitkunat4. 1. Medical Statistics and Epidemiology, P N Lee Statistics and Computing Ltd, Sutton, Surrey, UK. 2. Social and Behavioral Sciences, NYU School of Public Health, New York, NY. 3. Health Sciences, Ramboll US Corporation, Amherst, MA. 4. Clinical Science and Epidemiology, Philip Morris R&D, Philip Morris Products SA, Neuchâtel, Switzerland. 5. Regulatory Affairs, Altria Client Services LLC, Richmond, VA. 6. Computational Tools and Statistics, British American Tobacco (Investments) Ltd, Group R&D, Southampton, UK. 7. Scientific and Regulatory Affairs, Reynolds American Inc Services Company, Winston-Salem, NC. 8. Modelling, Ventana Systems UK Ltd, Salisbury, UK. 9. Department of Health Management and Policy School of Public Health, University of Michigan, Ann Arbor, MI. 10. Strategic Consulting, Certara USA Inc, Menlo Park, CA.
Abstract
INTRODUCTION: Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP). AIMS AND METHODS: We aimed to compare and contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018. RESULTS: Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the "null scenario" or joint smoking and MRTP habits in an "alternative scenario". The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized. CONCLUSIONS: Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction. IMPLICATIONS: There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates.
INTRODUCTION: Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP). AIMS AND METHODS: We aimed to compare and contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018. RESULTS: Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the "null scenario" or joint smoking and MRTP habits in an "alternative scenario". The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized. CONCLUSIONS: Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction. IMPLICATIONS: There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates.
Authors: Shari P Feirman; Allison M Glasser; Shyanika Rose; Ray Niaura; David B Abrams; Lyubov Teplitskaya; Andrea C Villanti Journal: Nicotine Tob Res Date: 2017-11-01 Impact factor: 4.244
Authors: Jamie Tam; David T Levy; Jihyoun Jeon; John Clarke; Scott Gilkeson; Tim Hall; Eric J Feuer; Theodore R Holford; Rafael Meza Journal: BMJ Open Date: 2018-03-23 Impact factor: 2.692
Authors: Raheema S Muhammad-Kah; Yezdi B Pithawalla; Edward L Boone; Lai Wei; Michael A Jones; Ryan A Black; Thomas M Bryan; Mohamadi A Sarkar Journal: Int J Environ Res Public Health Date: 2019-04-09 Impact factor: 3.390