HEALTH, ECONOMIC, AND EQUITY IMPACTS OF AD VALOREM, TIER-BASED, AND SUGAR CONTENT-BASED SUGAR-SWEETENED BEVERAGE TAX POLICIES IN THAILAND
Author(s)
Kittiphong Thiboonboon, PhD, Richard De Abreu Lourenco, PhD, Jody Church, MA, PhD, Stephen Goodall, PhD.
University of Technology Sydney, Centre for Health Economics Research and Evaluation, Ultimo, Australia.
University of Technology Sydney, Centre for Health Economics Research and Evaluation, Ultimo, Australia.
OBJECTIVES: Most sugar-sweetened beverage (SSB) tax evaluations focus on a single design, leaving unclear how alternative designs compare across health, economic, and equity outcomes. This study addresses this gap comparing four designs in Thailand.
METHODS: A deterministic individual-level cohort simulation model was developed using data from the 2021 national health survey weighted to represent 35 million Thai adults. Tax scenarios, including the current Thai tier-based tax, a 20% ad valorem tax, a sugar-content-based tax, and a modified Thai tier-based tax (reducing the current tax-free threshold) were compared with a no-tax scenario. Tax effects on SSB consumption were applied over 10 years, with lifetime outcomes modelled, including obesity cases avoided, quality-adjusted life years (QALYs) gained, medical costs, productivity gains, and tax burden. Equity outcomes were evaluated by socioeconomic status using the concentration index.
RESULTS: All four designs were projected to be cost-saving compared with the no-tax scenario. The sugar-content-based tax produced the largest health gains, avoiding 955,951 obesity cases and generating 3,893,564 QALYs gained, followed by the modified Thai tier-based tax (817,047 obesity cases avoided; 3,076,970 QALYs gained), the current Thai tier-based tax (704,192 obesity cases avoided; 2,636,194 QALYs gained), and the 20% ad valorem tax (387,798 obesity cases avoided; 1,278,094 QALYs gained). The sugar-content-based tax produced the largest economic gains, with US$521.1 million in medical cost savings and US$1,895 million in productivity gains. Health gains were more concentrated among higher socioeconomic groups under the tier-based and sugar-content-based taxes, but among lower socioeconomic groups under the ad valorem tax. The tax burden was regressive for all designs, particularly under the ad valorem tax and less so under tier-based and sugar-content-based taxes.
CONCLUSIONS: SSB tax impacts differ substantially by design. In Thailand, the current tier-based system could be strengthened through a lower tax-free threshold or translating to a sugar-content-based tax if administratively and politically feasible.
METHODS: A deterministic individual-level cohort simulation model was developed using data from the 2021 national health survey weighted to represent 35 million Thai adults. Tax scenarios, including the current Thai tier-based tax, a 20% ad valorem tax, a sugar-content-based tax, and a modified Thai tier-based tax (reducing the current tax-free threshold) were compared with a no-tax scenario. Tax effects on SSB consumption were applied over 10 years, with lifetime outcomes modelled, including obesity cases avoided, quality-adjusted life years (QALYs) gained, medical costs, productivity gains, and tax burden. Equity outcomes were evaluated by socioeconomic status using the concentration index.
RESULTS: All four designs were projected to be cost-saving compared with the no-tax scenario. The sugar-content-based tax produced the largest health gains, avoiding 955,951 obesity cases and generating 3,893,564 QALYs gained, followed by the modified Thai tier-based tax (817,047 obesity cases avoided; 3,076,970 QALYs gained), the current Thai tier-based tax (704,192 obesity cases avoided; 2,636,194 QALYs gained), and the 20% ad valorem tax (387,798 obesity cases avoided; 1,278,094 QALYs gained). The sugar-content-based tax produced the largest economic gains, with US$521.1 million in medical cost savings and US$1,895 million in productivity gains. Health gains were more concentrated among higher socioeconomic groups under the tier-based and sugar-content-based taxes, but among lower socioeconomic groups under the ad valorem tax. The tax burden was regressive for all designs, particularly under the ad valorem tax and less so under tier-based and sugar-content-based taxes.
CONCLUSIONS: SSB tax impacts differ substantially by design. In Thailand, the current tier-based system could be strengthened through a lower tax-free threshold or translating to a sugar-content-based tax if administratively and politically feasible.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE172
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)