Background:
The idea of whether cigarettes have become cheaper or more expensive over time can be answered in two ways, one with reference to real prices alone (i.e whether prices change in relation to the prices of other goods and services in a country) and the other with reference to smokers' ability to purchase cigarettes (i.e. whether cigarettes became more or less expensive relative to income).

Methods:
The affordability of cigarettes for each of the years 2008, 2010, 2012, 2014 and 2016 was measured by the per capita GDP required to purchase 2000 cigarettes of the most sold brand reported in that year, as also the cheapest and premium brands. To assess whether affordability changed on average since 2008, the average annual percentage change in affordability was calculated as the least squares growth rate for all countries with three or more years of data, including data for 2016. In addition, analysis of the direction and magnitude of year-by-year changes in affordability was conducted.

Results:
Cigarette price increases outpaced per capita GDP growth in 80 countries and did not significantly differ from per capita GDP growth in 73 countries, but fell short in 23 countries. The WHO Euro region, with the greatest prices and tax shares, has also seen the most success in reducing affordability of cigarettes. Countries at the top category of achievement in taxation in 2016 were also the most successful in ensuring that cigarettes, on average, became less affordable in the 8-year period since 2008. Few countries are able to make cigarettes less affordable in every successive year.

Conclusions:
Countries with the highest tobacco excise taxes have been the most successful at reducing the affordability of cigarettes. Measures of affordability are easy to compute and track policy change, but are most informative when averaged over multiple years given high annual variation.