Meta-Analysis of E-Cigarette Price Elasticity

Background: Adoption of electronic nicotine delivery systems (ENDS) has the potential to impact the prevalence of combusted cigarette use. Understanding whether and how much ENDS act as economic substitutes for cigarettes helps inform tobacco policy to minimize harm. Objectives: The goals of this study are to review the own-price elasticity of ENDS, the cross-price elasticity of ENDS with respect to cigarette price (including taxes), and the cross-price elasticity of cigarettes with respect to ENDS price. Methods: Pre-registered systematic review and meta-analysis following Cochrane review guidelines where applicable. Articles were sourced from PubMed and Google Scholar. Where appropriate, effects were combined in random-effects models with a two-step estimator. Other articles were reviewed narratively. Results: A 10% increase in ENDS price is associated with a 10.7% (7.7%–13.6%) decrease in ENDS sales/purchases, and also decreased ENDS use prevalence. A 10% increase in cigarette price is associated with an 18.3% (9.3%–27.4%) increase in ENDS sales/purchases, and also increased ENDS use prevalence. No evidence for increased cigarette sales/purchases after increased ENDS price was found, but increased ENDS price was associated with increased smoking prevalence, propensity, and number of cigarettes smoked. Discussion: These data suggest ENDS are substitutes for cigarettes. Taxing cigarettes encourages switching away from the more harmful product. More research is needed to clarify the association between ENDS price and cigarette demand. Conclusions: Policymakers should consider using taxation to influence behavior and tax tobacco products in proportion to their harm.