Introduction:
The aim of this study was to explore price and affordability of cigarettes and make comparisons across 15 European partner countries (Albania, Armenia, Belgium, Bulgaria, Georgia, Greece, Italy, Kosovo, Poland, Romania, Russia, Serbia, Slovenia, Spain, Ukraine) of EPACTT-2 (EuroPean Accreditation Curriculum on Tobacco Treatment) project that aims to develop and expand an accredited curriculum for tobacco treatment delivery .

Methods:
The structured 8-item self-administered questionnaire in English was distributed among partner country representatives. The questionnaire covered Marlboro and local cigarettes prices, as well as country profiles. To make comparisons across countries we converted local currencies into international dollars using the country specific purchasing power parity (PPP) conversion factor. Affordability was assessed by the relative income price (RIP) of cigarettes, which is the proportion of per capita GDP required to purchase 100 cigarette packs. Lower RIP corresponds to higher affordability.

Results:
Overall, fourteen countries (4 lower-middle income, 5 upper-middle income, and 5 high-income) participated in the online survey in 2017. The mean price of Marlboro was higher in high income countries compared to upper-middle and lower-middle income countries (6.65$, 6.02$, and 5.15$, respectively). Similar tendency was observed regarding to the mean price of local cigarette (5.83$, 3.96$ and 3.75$ in high, upper-middle and lower-middle income countries, respectively). However, in high income countries average RIP was lower than in upper-middle and lower-middle income countries: for Marlboro 1.88%, 3.45% and 5.52%, and for local cigarettes 1.66%, 2.49% and 4.07%, respectively.

Conclusions:
Although, cigarettes were more expensive in high income countries they were about two times more affordable than in upper-middle and about three times more affordable than in lower-middle income countries. Thus, financial burden of smoking on households is more pronounced in the countries with more limited resources.

Funding:
This study was supported by Global Bridges Healthcare Alliance for Tobacco Dependence Treatment hosted by Mayo Clinic and Pfizer Independent Grants for Learning and Change.