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Introduction: Taxing tobacco is one of the most effective ways to reduce smoking prevalence, mitigate its devastating consequential health harms, and progress towards a tobacco-free society. This study modelled the health and economic impacts of increasing the existing cigarette tobacco duty escalator (TDE) in the UK from the current 2% above consumer price inflation to 5%. Methods: A two-stage modelling process was used. Firstly, a non-linear multivariate regression model was fitted to cross-sectional smoking data, creating longitudinal projections from 2015 to 2035. Secondly, these projections were used to predict the future incidence, prevalence and cost of 17 smoking-related diseases using a Monte Carlo microsimulation approach. A sustained increase in the duty escalator was evaluated against a baseline of continuing historical smoking trends and the existing duty escalator. Results: A sustained increase in the TDE is projected to reduce adult smoking prevalence to 6% in 2035, from 10% in a baseline scenario. After increasing the TDE, only 65% of female and 60% of male would-be smokers would actually be smoking in 2035. The intervention is projected to avoid around 75,200 new cases of smoking-related diseases between 2015-2035. In 2035 alone, £49m in NHS and social care costs and £192m in societal premature mortality and morbidity costs is projected to be avoided. Conclusion: Increasing the UK TDE to 5% above inflation could effectively reduce smoking prevalence, prevent diseases, and avoid healthcare costs. It would deliver substantial progress towards a tobacco-free society, and should be implemented by the UK Government with urgency.

BACKGROUND: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England. METHOD AND FINDINGS: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data. CONCLUSIONS: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status.

Acknowledgements We thank the REBALANCE Advisory Group for all their advice and support during this project: Margaret Watson, Lorna Van Lierop, Richard Clarke, Jennifer Logue, Laura Stewart, Richard Welbourn, Jamie Blackshaw, Su Sethi. +Current address HealthLumen, London. The REBALANCE team Elisabet Jacobsen1, Dwayne Boyers1, David Cooper3, Lise Retat2, Paul Aveyard4, Fiona Stewart3, Graeme MacLennan3, Laura Webber2, Emily Corbould2, Benshuai Xu2, Abbygail Jaccard2, Bonnie Boyle3, Eilidh Duncan3, Michal Shimonovich3, Cynthia Fraser3, Lara Kemp3, Clare Robertson3, Zoë Skea3, Marijn de Bruin6, Alison Avenell3 Funding The project was funded by the NIHR Health Technology Assessment Programme (Project number: 15/09/04). See the HTA Programme website for further project information. The Health Economics and Health Services Research Units at the University of Aberdeen are core funded by the Chief Scientists Office (CSO) of the Scottish Government Health and Social Care Directorate. Correction | Open Access | Published: 26 August 2021 Correction: Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model. D. Boyers, L. Retat, E. Jacobsen, A. Avenell, P. Aveyard, E. Corbould, A. Jaccard, D. Cooper, C. Robertson, M. Aceves-Martins, B. Xu, Z. Skea, M. de Bruin & and the REBALANCE team. International Journal of Obesity (2021) The Original Article was published on 04 June 2021 Correction to: International Journal of Obesity https://doi.org/10.1038/s41366-021-00849-8 ; Peer reviewed ; Publisher PDF