The impact of e-cigarette taxation: a systematic review and meta-analysis on usage, pricing strategies, and public health implications

BACKGROUND: E-cigarette taxation has been increasingly implemented worldwide as a fiscal and regulatory tool to curb consumption, generate revenue, and mitigate public health risks. However, the effectiveness of such policies remains uncertain, particularly given differences in tax structures, market dynamics, and consumer behaviors. This study systematically reviews and synthesizes evidence on the impact of e-cigarette taxation on governments, businesses, and consumers. METHODS: Following PRISMA guidelines, seven electronic databases and grey literature sources were utilized to identify relevant studies. Eligible studies included quantitative research on e-cigarette taxation policies. Data synthesis involved a narrative summary focusing on tax pass-through rates and elasticity. Meta-analysis calculated pooled odds ratios (OR) for e-cigarette usage between tax and no tax groups. Quality assessment was conducted using JBI Critical Appraisal Checklists. RESULTS: A total of 27 studies were included. The meta-analysis based on three US studies suggested a modest reduction in e-cigarette use among adults (OR: 0.89, 95% CI: 0.84-0.94) and youth aged 18-24 (OR: 0.87, 95% CI: 0.78-0.98). Notable heterogeneity in tax elasticity was observed, ranging from - 0.62 to - 0.02, suggesting inelastic demand in some cases. Limited evidence suggested that e-cigarette taxation can increase fiscal revenue, although the absolute amount remains small compared with traditional tobacco excise revenue. The pass-through rate ranged from 0.07 in China to 1.67 in the USA, highlighting differences in company pricing strategies and market responses. The ad valorem taxes had a lower pass-through rate and higher effect than specific taxes. CONCLUSIONS: E-cigarette taxation impacts prices, sales, and consumption variably, influenced by tax policy specifics, market conditions, and stakeholder behavior. Coordinated tax design, aligned with broader regulatory and educational measures, is essential to enhance policy effectiveness and protect public health. TRIAL REGISTRATION: Prospero Registration Number CRD42023395112.