OBJECTIVES: Real-world data on the clinical and economic impact of switching from cigarettes to non-combustible (NC) tobacco products are lacking. This study describes select clinical outcomes and healthcare costs among adult males who continued to use combustible cigarettes (CS), switched to non-combustible smokeless products (ST), or quit tobacco (NT).

METHODS: This retrospective cohort study identified male smokers from the Merative™ MarketScan® Commercial and Medicare Databases between 2011-2021. Index date was the earliest claim indicating a switch to smokeless tobacco for ST cohort, earliest claim indicating prior tobacco use for NT cohort, and randomly assigned for CS cohort. Patients had ≥12 months of continuous enrollment (CE) prior to and 36 months of CE following index. Matching weights were employed to balance baseline characteristics. Clinical outcomes and healthcare costs were described during the 3-year follow-up.

RESULTS: Post-matching weights, approximately 1,349 patients were included in each cohort. Median age was 45 and 30% resided in a rural area. COPD exacerbations decreased from year 1 to 3 among the ST (0.8% to 0.4%) and NT (3.3% to 3.1%) cohorts and increase among CS cohort (2.8% to 3.3%). Compared to CS, ST and NT cohorts had 74% and 26% lower likelihood of developing COPD over the follow-up period, respectively. Ischemic heart disease trended toward a decrease among the ST (6.4% to 5.7%) and NT (10.9% to 10.8%) cohorts and increase among the CS cohort (8.6% to 9.4%). Total healthcare cost decreased among the ST (-$1,032), and NT (-$2,917) cohorts, and increased for CS cohort (+$1,438) during follow-up.

CONCLUSIONS: Consistent with epidemiological evidence, our findings demonstrated male smokers who switched to ST or quit saw reductions in select clinical and economic outcomes during follow-up while outcomes in continued smokers increased, supporting the potential of healthcare claims data for assessing harm-reduction potential of NC tobacco products.