Introduction: Waterpipe tobacco is taxed at half the rate of cigarettes in Egypt and, unlike cigarettes, does not have a specific excise component. We aimed to simulate the introduction of a specific excise tax on waterpipe tobacco consumption, premature deaths, and government waterpipe tobacco revenue in Egypt.
Methods: We took model inputs from the latest available data on consumption, market shares and market share prices, price elasticities of demand, tax structure, and from discussions with government officials. We modelled increases to specific excise to produce a 45%, 55%, 65%, and 75% tax burden and compared a simple (specific only) structure to a mixed (specific and ad valorem) structure.
Results: Under the simple approach, introducing a $2.1 (USD) specific tax would result in a 75% tax burden with 67% fewer waterpipe tobacco units smoked, 1,004,604 averted premature deaths, and a 236% increase in government revenue relative to the current tax structure. At the 75% tax burden, the simple approach resulted in 1.5% fewer waterpipe tobacco units consumed, 9,000 more averted premature deaths, and 12.7% more government revenue compared to the mixed approach. Results for other tax burdens are presented and remained robust to sensitivity analyses.
Conclusions: Introducing a specific excise tax on waterpipe tobacco in Egypt can yield considerable government revenue and public health gains. We recommend the simple approach, in line with the WHO recommendations, which produces greater economic and public health gains than the mixed approach and is easier to administer for the Egyptian government.