Health, Fiscal, and Societal Economic Consequences of Traditional Tobacco Control Policies and Generation-Based Sales Bans in Türkiye: A Dynamic Cohort Simulation Model
Ahmet Kar, Mehmet Enes GöklerAbstract
Introduction
Tobacco use remains a cause of avoidable disease and economic loss in Türkiye. Evidence is limited on the consequences of generation-based sales restrictions compared with conventional tobacco control.
Methods
We developed a dynamic open-cohort state-transition model of Türkiye's population aged ≥15 years. Over 50 annual cycles, baseline smoking was compared with enhanced cessation, stronger prevention, and a fully effective generation-based sales ban. Outcomes included smoking prevalence, disease cases and deaths, life-years, disability-adjusted life years (DALYs), healthcare savings, tobacco tax revenue, productivity, and household cigarette expenditure. Monetary outcomes were expressed in 2025 international dollars; uncertainty was assessed using 1,000 Monte Carlo simulations.
Results
By year 50, smoking prevalence was 30.4% under baseline, 27.5% with enhanced cessation, 24.2% with stronger prevention, and 5.6% under the generation-based sales ban. The ban prevented 8.45 million disease cases and 1.87 million disease-specific deaths and generated 10.48 million discounted life-years and 18.26 million discounted DALYs. Discounted healthcare savings were 3.64, 7.39, and 13.40 billion 2025 international dollars for cessation, prevention, and the ban; corresponding societal gains were 11.37, 27.55, and 61.85 billion. All policies reduced tobacco tax receipts, producing negative net fiscal effects.
Conclusions
A fully effective generation-based sales ban produced the largest health and societal gains. It should complement cessation support and conventional tobacco control, with planning for declining tobacco tax revenue.