BACKGROUND: India faces a dual tobacco epidemic, with 28.6% of its adult population using tobacco in either combustible or smokeless forms. Tobacco consumption significantly contributes to morbidity, mortality, and economic losses, exacerbating public health challenges. This study evaluates the health and economic burden of tobacco use and estimates the benefits of tax-based control measures.
METHODS: A Markov probabilistic microsimulation model was employed to estimate tobacco-attributable disease burden, mortality, and economic costs -treatment, productivity and informal care- stratified by mode of tobacco use -combustible or smokeless- and sex, and health and economic impacts of a 50% increase in price due to tobacco taxes. The model incorporated data from the Global Adult Tobacco Survey, the Global Burden of Disease study, and economic parameters identified through a comprehensive literature review. These inputs were rigorously calibrated to ensure alignment with demographic and epidemiological characteristics.
RESULTS: Combustible tobacco is responsible for approximately 922.000 deaths and 8.9 million disease events annually, while smokeless tobacco contributes to 165.000 deaths and 400.000 disease events. The economic burden amounts INR 3.56 trillion for combustible tobacco and INR 358 billion for smokeless tobacco which represents 1.21% and 0.14% of the gross domestic product. Results indicate that a 50% tax increase could avert 1.8 million deaths, save 66.8 million healthy life-years, and yield economic benefits exceeding INR 11.9 trillion over a decade.
CONCLUSIONS: This research highlights the urgent need for stronger tobacco control policies to address the persistent burden of tobacco use in India. These findings demonstrate that taxation is a powerful strategy to combat the dual epidemic of combustible and smokeless tobacco in India, reducing mortality, morbidity, and economic losses while supporting public health and economic resilience.