Impact of tobacco price and taxation on affordability and
consumption of tobacco products in the South-East Asia
Region: A systematic review

Introduction:
The objective of the review was to study the impact of tobacco taxes or prices on affordability and/or consumption of tobacco products in WHO South- East Asia Region (SEAR) countries, overall and by socioeconomic status; and change in consumption of one tobacco product for a given change in price/tax on another tobacco product.

Methods:
The searches were made in five databases (Medline, Embase, Cinahl, EconLit, Tobacconomics) using keywords such as ‘tobacco’, ‘tax’, ‘price’, ‘impact’ with their synonyms. Additionally, the first 100 articles through google search and e-reports from targeted sources were also reviewed. Studies illustrating the impact of prices/taxes on consumption/affordability of tobacco products in SEAR, in English and with no limitation on year, were included in the review. After two steps of screening, data from 28 studies were extracted using a structured and pre-tested data extraction form.

Results:
Of the 28 studies, 12 studies reported an inverse association between price and consumption/affordability, while 11 studies reported no or positive association between price and consumption/affordability of tobacco products. Five studies had unclear interpretations. The majority of studies estimated that the less affluent group were more price responsive compared to the more affluent group. Some studies indicated increased consumption of one product in response to price rise of another product, although, the findings were inconsistent.

Conclusions:
The findings of our review support the use of tobacco tax and price measures as effective tools to address the tobacco epidemic. Our findings, however, also emphasize the importance of increasing tobacco product taxes and prices sufficiently to outweigh the effects of income growth, in order for the measures to be effective in reducing the affordability and consumption of tobacco products.

CONFLICTS OF INTEREST

The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. All the authors report that since the initial planning of the work and in the past 36 months this research was completed as part of the Tobacco Control Capacity program and it was supported by UKRI Global Challenges Research Fund (MR/P027946/2).

FUNDING

This research was completed as part of the Tobacco Control Capacity program. This work was supported by UKRI Global Challenges Research Fund (MR/P027946/2). The Tobacco Control Capacity program is a capacity development and research coordinated by the University of Edinburgh, Scotland, and involves 15 partner institutions from Africa, South Asia and the United Kingdom.

ETHICAL APPROVAL AND INFORMED CONSENT

Ethical approval and informed consent were not required for this review.

DATA AVAILABILITY

The data supporting this research can be found in the Supplementary file.

AUTHORS' CONTRIBUTIONS

GPN, MA, RH and NDM were involved in the concept and design of the study. NS, SL and AC contributed to literature searches. LB and MA secured funding for the study. NS and SMA contributed to data extraction. AC, SMA and GPN contributed to the critical appraisal of studies. GPN and NS contributed to data synthesis. GPN, NS and AC prepared the first draft of the manuscript. GPN, MA, RH, SMA, NDM, RMJ and LB reviewed the manuscript critically for intellectual content. All authors approved the final version of the manuscript submitted.

PROVENANCE AND PEER REVIEW

Not commissioned; externally peer reviewed.

REFERENCES (64)

Nargis N, Stoklosa M, Shang C, Drope J. Price, Income, and Affordability as the Determinants of Tobacco Consumption: A Practitioner's Guide to Tobacco Taxation. Nicotine Tob Res. 2021;23(1):40-47. doi:10.1093/ntr/ntaa134.