Impact of reducing nicotine in cigarettes on mortality, economic costs and major depression in the USA

Introduction The US Food and Drug Administration has proposed a product standard that would reduce the nicotine content and addictiveness of cigarettes. It is unclear what impact this would have on economic outcomes or priority populations who are disproportionately harmed by tobacco use, such as people with major depression (MD). We evaluated the long-term health and economic impacts of a nicotine product standard for the US population by MD status.Methods We developed and calibrated a microsimulation model using the National Survey on Drug Use and Health 2005–2023 data on smoking, e-cigarette use and MD episodes. We used this model to simulate a nicotine product standard from 2027 to 2100 based on the FDA’s expert elicitation estimates of the policy’s anticipated effects on smoking and vaping.Results Under the proposed product standard, smoking is projected to decline to <1% for people with and without MD by 2040, resulting in 1.6 million premature deaths averted by 2100 and 8.0 million fewer cases of MD. Longer life expectancies under the policy are projected to increase medical costs by US$336 billion, while also increasing worker productivity by US$298 billion and consumer spending by US$1.3 trillion.Conclusions Timely implementation of a nicotine reduction strategy, either through a federal product standard or state-level sales restrictions, is cost-effective and could prevent millions of premature deaths while reducing smoking disparities by MD status.