This can be partly attributed to 'survivor bias', i. For example, in the US study of health maintenance organisation members, 6 mentioned above, the usage of most health services was higher for former smokers than current smokers, but the longer the time since quitting, the lower the hospital discharge rate. Other studies 16 , 17 similarly find an association between cessation and healthcare costs. A study of health plan members in Minnesota from to found that higher health care costs increased the likelihood of a smoking cessation attempt.
Another found that it took twice as long 10 years rather than five years for medical charges after smoking cessation to drop to the level of non-smokers if the smoker had one of three smoking-related chronic conditions arthritis, allergies or back pain.
It should be noted that excess utilisation of services by smokers could be due partly to other risk factors that might also be higher among the population of people who smoke. On the other hand, studies observing excess utilisation of health care services would pick up the effects of all diseases caused or worsened by smoking, including those for which aetiological fractions have not yet been developed.
While smokers no doubt use more health services than non-smokers of the same age, some commentators have claimed that these higher costs are likely to be offset by the fact that smokers die earlier, thereby reducing total lifetime use of health care services. Models developed to estimate the lifetime costs for smokers and non-smokers link data on life expectancy with per capita cost data. Note that the magnitude of the lifetime cost will depend on the age from which the estimate starts; lifetime costs from age 20 years, for example, will be larger than those from age 40 years, if all other assumptions are identical.
The discount rate is also relevant. As mentioned in Section Some researchers looking at this question have indeed concluded that the lifetime health care costs for smokers are lower than for non-smokers. In the models these researchers used, the health care cost savings attributed to smokers' premature death from smoking-associated illnesses more than offset their higher annual medical costs.
The key studies addressing this issue are summarised in Table Several critiques of studies that report lower lifetime costs for smokers 22 , 24 argue that their results are due to underestimation of annual health care costs for smokers and discount rates that are too low. Further, such studies may inappropriately focus on undiscounted lifetime costs.
A major report published in by the National Cancer Institute and World Health Organization concluded that in high-income countries, lifetime health care costs are greater for smokers than for non-smokers, even after accounting for the shorter lives of smokers.
Difference in lifetime medical costs between a continuing smoker and a smoker who quits at age As well as healthcare, many smokers who develop smoking-related disease require social care.
That is, support to help them complete day-to-day activities such as washing, dressing and eating. The average age at which someone develops a social care need for the first time is 62 for smokers, compared to 72 for never-smokers.
About one in four Studies in Finland, 30 Germany, 31 and Sweden 32,33 have similarly found that the likelihood of receiving a disability pension is higher for smokers than non-smokers. One of the Swedish studies, for example, followed over 45, men for 38 years and found that men who smoked more than 10 cigarettes per day were twice as likely to receive a disability pension as non-smokers. An alternative approach to quantifying the costs of smoking is to calculate the percentage of deaths and health care services attributable to smoking based on accepted estimates of the excess risk posed to an individual by smoking, taking into account other risk factors.
Worldwide, smoking is a leading preventable cause of morbidity and mortality, and in Australia is consistently the number one risk factor contributing to disease burden and deaths see Section 3. A systematic review published in found that an unhealthy diet, tobacco use, and alcohol consumption are the biggest contributors to preventable disease in Australia.
Tobacco use accounted for over half of all years of healthy life lost due to lip and oral cavity cancer, nasopharynx cancer, oesophageal cancer, and around three quarters of larynx cancer and tracheal, bronchus and lung cancer. The Australian Burden of Disease study examines the role of 30 risk factors, including seven behavioural risk factors tobacco use, alcohol use, physical inactivity, drug use, intimate partner violence, childhood sexual abuse, and unsafe sex. It estimated that in , 4.
The risk factors contributing the most burden in were tobacco use 8. It was responsible for The Global Burden of Disease GBD study estimates levels and trends in exposure, attributable deaths, and attributable DALYs, by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks factors.
Researchers in the US linked data on smoking in the home, from National Health Interview Surveys and , and health service usage and costs for almost children aged less than five years, from Medical Expenditure Panel Surveys and Of children exposed to smoking at home, 4. A more recent study found that, despite declining over time, US healthcare costs attributable to secondhand smoke exposure at home were still substantial.
Infants and children of women who smoke during pregnancy also have higher healthcare costs during their early childhood. Cardiovascular diseases particularly coronary heart disease , respiratory diseases especially COPD and malignant neoplasms such as lung cancer were the disease categories responsible for the bulk of the direct costs.
The indirect costs of smoking, such as lost productivity, often greatly exceed the direct costs to the health system. The number of labour years lost which includes the future labour years foregone until retirement due to smoking-attributable diseases was A novel Australian study published in calculated productivity-adjusted life years PALYs lost due to smoking in Australia.
PALYs are a construct similar to quality-adjusted life years QALYs , but account for loss of productivity accrued from a combination of premature death, sick days, and reductions in productive capacity while at work rather than loss of quality of life. Assuming follow up of the current Australian smoking population to the age of 70 years, it estimated that 2. At an individual level, this is equivalent to 1.
A systematic review and meta-analysis published in found robust evidence that smoking increases both the risk and number of sick days in working populations, regardless of study location, gender, age, and occupational class. The Finnish study found that smoking and obesity were the two health-related behaviours most associated with sick leave; The costs of health care and other effects of tobacco caused disease is only one of many costs attributable to smoking that are born by Australian society.
In work spanning three decades, economists Professor David Collins and Ms Helen Lapsley have undertaken a comprehensive series of studies aiming to estimate the total costs of tobacco use to the broader Australian economy. In reports for the Department of Health and Ageing, Collins and Lapsley have estimated the social costs of tobacco use in Australian society for the years , 57 , 58 —99 59 and — The main features of the approach and the findings for the —05 report the final in the series are summarised below A study undertaken by Curtin University has extended the Collins and Lapsley program and—using a slightly different method—produced an updated estimate for the year — Second, in contrast to the burden of disease study described in Section They compare the actual population size and structure in the specified year with a hypothetical alternative population in which there was no past abuse and there is no current abuse.
Costs of past and present abuse are estimated in the year of the study only. So, for example, the cost in —05 of a death due to tobacco smoking death that occurred either in or before the year —05 is estimated as the value of lost productive capacity in that year only.
The value of a lost life, i. Third, Collins and Lapsley estimate the net costs of smoking, taking into account both those costs that are made greater and those that are reduced because of current and past tobacco use. For example, smoking increases some health care costs because of the higher prevalence of diseases caused by smoking in smokers and ex-smokers who are still alive. These are the gross health care costs attributable to smoking. However, certain other health care costs are lower than they otherwise would be because of the premature deaths of many people who smoked over the past 40 years.
These people did not live to use health care that they otherwise would have, so Collins and Lapsley subtract the costs that would have been incurred from the gross health care costs attributable to smoking in order to estimate the net cost. Similarly, in terms of labour production costs first costs that are made greater by smoking are estimated.
For example, the time spent undertaking domestic duties because a home-maker is ill or has died prematurely is costed assuming domestic help will be hired. Then, savings due to reduced consumption—for example, household spending on food and clothing—are subtracted because these costs will be lower when there are fewer people in the household as a result of smokers dying earlier. Costs did not decrease because the impact of the previous decades of tobacco use was still being observed in — Table The social costs of tobacco to Australian society in and adjusted to prices.
Collins and Lapsley include the following resources in their estimates of tangible costs: lost productive capacity due to premature death or smoking-associated illness labour costs , health care for smoking-associated illness, fires attributable to smoking, and abusive consumption i.
They define the intangible costs of tobacco abuse as the sum of the psychological costs of premature death incurred by family and friends and the loss of enjoyment of life incurred by the smoker as a consequence of smoking-associated illness.
Estimates of tangible costs are summarised in more detail in Table Workforce labour costs were further disaggregated into reduction in the workforce due to premature death and absenteeism due to smoking-associated illness. Reduced on-the-job productivity due to smoking was not included in their estimates because of lack of data.
Costs due to the reduced workforce size were estimated from national accounts data. The estimate for absenteeism was based on Australian research which found that smokers were 1. Household labour costs due to smoking were valued using Australian Bureau of Statistics methodology; the cost of hiring the market replacement for each individual household function was used to estimate the value of time lost due to death or illness.
Lack of data prevented Collins and Lapsley assigning values to many of the social costs known to be attributable to smoking. For example, the following are not included: the purchase of over-the-counter medicines, domiciliary care and allied health services. However, a study published in estimated that between eight to 30 minutes per day are lost due to smoking. Collin and Lapsley also note that some of their cost estimates were almost certainly too low.
For example, the cost of pharmaceutical products is based only on the highest volume drug categories on the Pharmaceutical Benefits Scheme.
The hospital cost estimates are based on average treatment costs for each condition and do not reflect the fact that health care costs for smokers are likely to be higher than for non-smokers. In , an updated estimate of the social costs of tobacco use in Australia was published, produced by The National Drug Research Institute at Curtin University. However, different assumptions and methods were used in each study, particularly in relation to the estimation of the intangible costs of premature mortality see chapter 11 of the report for a detailed discussion.
Conditions now known to be caused by smoking were added to the list of adverse health outcomes e. Other factors such as the ageing of the Australian population, and the increase in the population, have also contributed to the higher overall cost of smoking in — Tangible costs of premature mortality include: the present value of lost expected lifetime labour in paid employment; costs to employers of workplace disruption; the lifetime value of lost labour in the household; and, a net cost saving of avoided lifetime medical expenditure by government.
In addition, employers face one-off costs to recruit and train new employees to replace deceased workers. Applying the estimate of 3, A household activity is considered unpaid work if someone could be paid to complete the same task; for example, domestic activities, childcare, purchasing of goods and services, and volunteer and community work.
These services would be lost by the community in the event of the death or severe illness of the person supplying them. Premature deaths of smokers produce reductions in lifetime healthcare costs which would have incurred in future years had the person lived to their expected age at death. The estimated average number of smoking attributable cases of stillbirths was In , daily smokers, occasional smokers, and ex-smokers reported missing an extra 11,, days from work per year compared to workers who had never smoked.
These differences ranged from 1. Smoking is associated with a plethora of adverse health outcomes and therefore costs arising from the use of health services in treating these conditions. Such costs include hospitalisations, excess emergency department visits, outpatient treatment, general practitioner visits, nursing home care and medications.
High-level residential care i. Further, a substantial amount of care is provided informally by family and friends. The cost of landscape fires was unable to be estimated. Discarded cigarette butts and packaging have a substantial environmental impact; in —15, cigarette butts were the most frequently identified litter item in Australia see Section The costs of tobacco consumed by smokers was also calculated, where the costs were borne by the smoker themselves and where the expenditure was not fully voluntary nor well informed i.
In addition to the tangible costs of smoking, there are substantial intangible costs e. The tobacco industry has often argued both in Australia and elsewhere that it generates much-needed employment and government revenue. Although there is a lack of consistent and comprehensive data on trends in global tobacco-related employment growing, manufacturing, and retailing , evidence strongly suggests that it has decreased over time.
Australian researchers have documented the ubiquity of tobacco retail outlets, which are disproportionately concentrated in disadvantaged neighbourhoods see also Section Although retailers often perceive tobacco to play an important role in their overall profitability and patronage, there is little evidence to support this—see Section However, the effectiveness of this restriction has been called to question as children are able to obtain cigarettes from their older friends, siblings, or vending machines.
Paper subject to independent expert blind peer review by minimum of two reviewers. All editorial decisions made by independent academic editor. Upon submission manuscript was subject to anti-plagiarism scanning. Prior to publication all authors have given signed confirmation of agreement to article publication and compliance with all applicable ethical and legal requirements, including the accuracy of author and contributor information, disclosure of competing interests and funding sources, compliance with ethical requirements relating to human and animal study participants, and compliance with any copyright requirements of third parties.
Author Contributions. Conceived and designed the experiments: VE and AB. Analyzed the data: VE. Wrote the first draft of the manuscript: VE. Contributed to the writing of the manuscript: AB. Agree with manuscript results and conclusions: VE and AB.
Jointly developed the structure and arguments for the paper: VE and AB. Made critical revisions and approved final version: VE and AB. All authors reviewed and approved of the final manuscript.
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Including indirect cost and benefits of smoking cessation interventions further strengthens the result with the extended course of varenicline dominating all other alternatives considered. Oh et al Korea To evaluate the cost and effectiveness of the nationwide government-sponsored smoking cessation clinics Cost-effectiveness analysis; sensitivity analysis Self-reported quit rates; cost per quitter; cost per service user; cost per life-year saved 1.
A total of , smokers used the Smoking Cessation Clinics in Estimated 1-year and 8-year quit rates were Javitz et al Seattle, WA, USA To evaluate the cost effectiveness of varencline and three different behavioral treatment formats for smoking cessation: proactive telephone counseling PTC , Web-based program, and a combination of PTC and web-based program Behavioral intervention; cost effectiveness analysis; sensitivity analyses Average cost of telephone minute; costs per enrollee for the Web group; varenicline drug cost per enrollee; cost per lifetime quitter; cost per additional 6 months nonsmoker and additional lifetime quitter; cost per LY and QALY 1.
Based on the cost per LY and QALY saved, these interventions are among the most cost-effective life-saving medical treatments. Chen et al Taiwan To evaluate the costs and benefits of the Outpatient Smoking Cessation Services OSCS program in Taiwan from a societal view point Cost—benefit analysis; primary and secondary data; sensitivity analyses The costs measured include cost to the health sector, non-health sectors, the patients, and their family, as well as loss of productivity as a result of smoking; Benefits measures include the medical costs savings and the earnings due to the increased life expectancy of a person who has stopped smoking for 15 years 1.
There were , subjects who participated in the OSCS in the years and , and, of those cases, successfully stopped smoking. Taylor et al UK To determine the incremental cost effectiveness of NRT, bupropion, and varenicline for preventing relapse to smoking when used by abstinent smokers Cohort simulation and sensitivity analyses Incremental health gain in quality of adjusted life years QALYs generated by each drug compared to no intervention Bupropion resulted in an incremental QALY increase of 0.
Tran et al Canada To evaluate the clinical and cost effectiveness of pharmacological-based strategies for smoking cessation Randomized controlled trials RCTs ; meta analyses; decision analytic model; budget impact analysis; Bayesian random effects model Cost per additional quitter and cost per life-year gained; cost per quality-adjusted life year QALY gained of NRT, bupropion, and varenicline compared with no pharmacological treatment; willingness to pay WTP per QALY 1.
For all ages and sexes, bupropion and varenicline dominated ie, cost less and was more effective nicotine gum, patch, lozenge, and inhaler. Varenicle is more cost effective and more cost saving than NRT: Number of morbidities avoided, per 1, smokers attempting to quit, ranged from 9. Boyd and Briggs UK To examine the cost effectiveness of pharmacy-based support versus group-based support for smoking cessation Observational study and NHS data Routine monitoring data on resource use and smoking status carbon monoxide-validated, self-reported, nonquitters and relapsers at 4-week follow-up 1.
Policy-based interventions Arslanhan et al Turkey To evaluate the costs and benefits of various tobacco elimination policies, specifically, an immediate taxation option and eight tax-combined long-term cessation programs Cost—benefit analysis; demographic projections Net social cost and net public benefits of tax increases; increase in average price of cigarettes due to tax raise; cigarette consumption due to tax raise; cost per quitter 1.
Net public benefit is positive only for tax rates between In fact, between these two values, the relationship between net public benefit and tax rates is a single-hump-shaped Laffer curve. This means that there is a tax rate that maximizes net public benefit. Net public benefit reaches its maximum at the tax rate of Cigarette consumption drops to , million packages at At The tax-combined cessation programs yield lower net costs to households and the society and also yield significant reductions in the expected number of smoking-related diseases and deaths.
After 1 year, it is estimated that a complete smoking ban in Gujarat would avert 17, additional heart attacks and gain , life years. A complete ban is highly cost effective when key variables including legislation effectiveness were varied in the sensitivity analyses.
Implementing a complete smoking ban would be a cost-saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat. Hu et al China To identify key economic issues involved in raising tobacco tax Estimated price elasticity of demand for cigarettes, prevalence data, and epidemiology Cigarette consumption, lives saved, government tax revenue, employment, revenue loss in the cigarette industry and tobacco farming 1.
Ahmad and Franz USA To estimate health and economic outcomes of raising the excise taxes on cigarettes Dynamic computer simulation model; sensitivity analysis on price elasticity Reduction in smoking prevalence due to price increases; QALYs; health care savings realized; changes in tax revenues amount of taxes gained or lost 1. These benefits increase greatly with larger tax increases, and tax revenues continue to rise even as smoking prevalence falls.
Ahmad a California, USA To evaluate the health and economic benefits of raising excise taxes on cigarettes in California Dynamic computer simulation model Reduction in smoking prevalence due to price increases; QALYs; health care savings realised; changes in tax revenues amount of taxes gained or lost 1. These benefits increase greatly with larger tax increases, with which tax revenues continue to rise even as smoking prevalence falls.
Ahmad b California, USA To evaluate the cost effectiveness of raising the legal smoking age in California state to 21 Cost benefit analysis; dynamic computer simulation model Reducing in smoking prevalence; change in cumulative quality-adjusted life years QALYs ; medical cost savings; cost of law enforcement; and cost of checking identification 1.
Compared to a status quo simulation, raising the smoking age to 21 would result in a drop in teen ages 14—17 smoking prevalence from Ahmad c USA To evaluate the projected health benefits and cost savings of a national policy to raise the legal smoking age to 21 in the US Cost—benefit analysis; dynamic computer simulation model Reducing in smoking prevalence; change in cumulative quality-adjusted life years QALYs ; medical cost savings; cost of law enforcement; and cost of checking identification 1.
This reduction grew over time, reaching 7. Thavorn and Chaiyakunap ruk Thailand To estimate the incremental cost—effectiveness ratio of a structured community pharmacist-based smoking cessation program compared with usual care Markov model Cost per life year gained LYG attributable to the smoking cessation programm 1.
The community pharmacist-based smoking cessation CPSC programme results in cost savings of 17, A series of sensitivity analyses demonstrate that both cost savings and life year gains are sensitive to variations in the discount rate and the long-term smoking quit rate associated with the intervention.
Three months after the day, about 85, smokers representing about 0. The cost effectiveness of this project compares favorably with other tobacco control interventions.
Godfrey et al UK To investigate the cost effectiveness of English specialist smoking cessation services Observational cost and outcome data; Multivariate analysis Cost—effectiveness ratios; smoking cessation rates attributable to service intervention as well as attributable life-years gained. Model assumed that if current public policies on smoking were maintained, smoking prevalence in NSW will reduce from Stevens, Thorogood, and Kayikki London, UK To evaluate the cost effectiveness of a community smoking cessation intervention, aimed at a high risk Turkish community in London Monte Carlo simulation; sensitivity analyses Cost per 1 year quitter; cost per life year saved 1.
Levels were particularly high in younger women. At follow-up, there was a net reduction in smokers of 6. When all study subjects were included, the net reduction was 2. Most quitters were light smokers to start with. Campaigns targeted at groups with high smoking prevalence may be more cost effectiveness than general population campaigns. Telecoms, media, and technology-based interventions Clayforth et al Western Australia To assess the relative cost effectiveness of various non-television advertising media in encouraging 25—year-old male smokers to respond to a cessation-related call to action Testimonial advertisements for radio, press and online media; sensitivity analysis Costs per additional call to the quitline; costs per additional visit to the website; costs per additional registrations for QuitCoach; costs per additional registration for the call-back counseling service; costs per unweighted total of additional events; costs per weighted total of additional events 1.
Clearly, the online-only campaign phase was substantially more cost effective than the other phases, including the integrated approach. A total of ex-smokers have been estimated to gain life years based on continued abstinence over 12 months. Using the point prevalence abstinence at 12 months, ex-smokers are estimated to gain 3, life years. Smit et al Netherlands To assess the cost effectiveness and cost utility of an internet-based multiple computer tailoring smoking cessation program and tailored counseling by practice nurses working in Dutch general practices compared with an internet-based multiple computer-tailored program only and care as usual Randomized control trial RCT , sensitivity analyses Self-reported cost and quality of life at month follow-up; prolonged abstinence; hour and 7-hour point prevalence abstinence at month follow-up; incremental cost effectiveness ratio ICER 1.
No significant differences were found between the intervention arms with regard to baseline characteristics or effects on abstinence, quality of life, and addiction level. However, participants in the multiple tailoring and counseling group reported significantly more annual health care-related costs than participants in the usual care group.
Cost—effectiveness analysis, using prolonged abstinence as the outcome measure, showed that the mere multiple computer-tailored program had the highest probability of being cost effective.
With regard to cost-utility analyses, using quality of life as the outcome measure, usual care was probably most efficient. Guerriero et al UK To examine the cost effectiveness of smoking-cessation support delivered by mobile phone text messaging Incremental cost—benefit analysis, Markov model, deterministic sensitivity analyses, probabilistic sensitivity analyses Life years LYs gained per quitter, cost of text based support per number of enrolled smokers 1.
Similarly, the probabilistic sensitivity analysis indicated a. Making some form of electronic support available to smokers actively seeking to quit is highly likely to be cost effective. The effectiveness of electronic interventions does not seem to be sensitive to cost differentials. However, the key source of uncertainty is that which relates to the comparative effectiveness of different types of electronic interventions. Data from eight designated media market areas studied indicate that in a hypothetical nationwide cohort of 2,, adult smokers ages 18—49, EX resulted in 52, additional quit attempts and 4, additional quits and saved 4, QALYs.
Smith et al USA To evaluate the incremental effectiveness and cost-effectiveness of a stage-based, computerized smoking cessation intervention relative to standard care in an urban managed care network of primary care physicians Decision-analytic model based on results of a randomized clinical trial RCT ; sensitivity analyses Seven-day point prevalence abstinence at 6 months post-intervention; QALYs; cost per patient per life year saved and per QALYs saved 1.
Intervention patients were 1. The intervention generated an additional 3. The largest effect was for TV advertising.
School-based interventions Brown et al India To evaluate the cost effectiveness of a youth tobacco use prevention program, known as Mobilizing Youths for Tobacco-Related Initiatives MYTRI , which has been translated and implemented in India, a developing country Cost effectiveness ratio CER , both quality adjusted and non-quality adjusted Dollars per life year added due to intervention 1.
The tobacco use progression model showed that approximately 12 people were projected to avert tobacco use by age 26 due to MYTRI. If quality-adjusted, this rises to 54 life-years. Euro direct net benefits and Euro total net benefits. Data suggests that the SFC is a cost-effective school-based intervention.
Results showed TNT to be cost-saving over a reasonable range of model parameter estimates. Sensitivity analysis reveals that cost effectiveness varies with cost, survival, and quality of life estimates but cost effectiveness ratios generally remain favorable. Group therapy programs OR for cessation 1. Individual counseling OR 1. Pharmacotherapies OR 1. Multiple intervention programmes aimed mainly or solely at smoking cessation OR 1.
Self-help materials were less effective OR 1. Two relapse prevention programs participants did not help to sustain long-term abstinence. Jackson et al USA To conduct a cost—benefit analysis CBA of varenicline versus bupropion from the perspective of an employer over a 1-year time frame, using clinical outcomes data Decision tree model, sensitivity analyses Smoking status, medication compliance, abstinence rates and quit rates with placebo, varenicle and bupropion, net benefits of changes in cost savings to employer for each employee who had quit smoking 1.
Varenicline was more cost beneficial than placebo, which had quit rates of Ong and Glantz USA To estimate the cardiovascular health and economic effects of smoke-free workplaces Monte Carlo simulation; sensitivity analyses Number of quitters after smoke-free workplace policy within 1 year; savings from prevented myocardial infarctions; savings from prevented stroke; savings from prevented myocardial infarctions in previous passive smokers 1.
The first year effect of making all workplaces smoke free would produce about 1. Warner et al USA To examine the health and economic implications of a workplace smoking cessation program by using a simulation model that includes, among its novel features, consideration of long-term as well as short-term implications and evaluation of the effects of employee turn-over on benefits derived by both the firm and the broader community.
Cohort model, Monte Carlo simulation, sensitivity analysis Health and behavioral out-comes: amount of smoking cessation, reductions in number of deaths, gains in life expectancy and reductions in absenteeism. Economic and financial outcomes include: intervention costs, reductions in health care costs, absenteeism costs, on-the-job-productivity losses, and life insurance costs Net cost savings benefit—cost ratio 1.
Smoking cessation is a very sound economic investment for the firm, and is particularly profitable when long-term benefits are included, with an eventual benefit—cost ratio of 8. Selection criteria The paper includes cost-effectiveness studies from medical journals, health reports, and white papers published between and July , but included only eight relevant studies before Data collection and analysis The included studies were assessed against criteria indicated in the Cochrane Reviewers Handbook version 5.
Keywords: smoking prevalence, economic impact, smoking cessation, effectiveness, cost effectiveness, cost—benefit analysis. Background It is a known fact that both active and passive smoking are damaging to human health and have associated economic costs.
The paper examines the following research questions: What are the economic costs and benefits of smoking? Research Methods Search methods and selection criteria: overview A systematic review produced several studies, out of which a total of 99 literature sources on the economics of smoking and of reducing smoking prevalence were used for the review.
Identification of studies Two main electronic databases were searched. Data extraction and management Data were extracted from published sources using a standard data recording form. Figure 1. Risk of bias The risk of bias in studies was assessed via the criteria described in version 5. Measures of evaluating economic impact We now discuss two methods commonly used by medical researchers for economic evaluation: cost effective analysis CEA and cost-benefit analysis CBA.
Cost effectiveness analysis CEA is a measure of cost savings. Cost—benefit analysis CBA is an economic technique that is used in evaluating the economic soundness or feasibility of an intervention program. Figure 2. Smoking-attributable costs and benefits As shown earlier, the costs of smoking can be classified into health-related costs and non-health-related costs. Health-related costs The health care costs associated with tobacco-related illnesses are extremely high.
Non-health-related costs Besides the health care costs of smoking, there are other costs that the abuse of tobacco imposes on society, and these costs need not be treated as less important. Economic benefits of smoking The cost of smoking notwithstanding, the tobacco industry poses a great deal of benefits, especially to the economy, consumers, and producers.
Effectiveness and cost effectiveness of smoking cessation interventions Because the health hazards attributable to smoking are very significant, the risks of illness or disease are reduced following smoking-cessation interventions. Pharmacological treatment interventions There are several pharmacological agents that are commonly used to aid smokers in their quest to quit smoking.
The economics of policy-based interventions This subsection takes a look at the global evidence on the economic consequences of policy-based measures that aid smoking cessation. Increase in tobacco taxes The most widely used measure to reduce the demand for tobacco is increase in taxes. Smoking restrictions in the work place and in public places It is in recognition of the dangers of passive smoking that many governments institute no smoking restrictions in public places eg, bars, restaurants, public buses, trains, airports, government buildings, and other public facilities and private workplaces.
Bans on tobacco advertisement Tobacco remains the second most heavily advertised product in the United States besides the automobile industry. Community-based intervention programs Smoking cessation programs also come in the form of community-based interventions to educate, inform, and assist smokers in their quitting attempts.
Telecoms, media, and technology-based interventions TMT-based interventions refer to electronic and mass media-related means aimed at offering support to effect changes in smoking behavior in adults and young adolescents. Telephone counselling, quitlines and text messaging Telephone services can provide information and support for smokers. Mass-media-led interventions Mass media interventions consist of the dissemination through television, radio, print media, and billboards of cessation-related messages, informing smokers and motivating them to quit.
Computer- and internet-based programs Personal computers, the Internet, and other electronic aids, which are now an indispensable part of daily life for many people around the world, also offer additional means of effecting changes to smoking behavior. School-based interventions Though the majority of smoking-related deaths occur in people aged 35 years or older, the onset of tobacco use occurs primarily in early adolescence, which makes adolescents a special target for smoking prevention projects.
Workplace interventions There has been growing interest within the business community regarding interventions against smoking in the workplace. The effectiveness and cost effectiveness of UK-specific smoking cessation programs This section takes a look at the effectiveness and cost effectiveness of smoking cessation interventions that are specific to the UK and identifies where there are any cost savings or net benefits to the health care system arising from a reduction in smoking prevalence.
Community pharmacy-based smoking cessation Crealey et al have looked at the cost effectiveness of a community pharmacy-based smoking cessation program in Northern Ireland. Action Heart promotion program Action Heart is a cost-effective, community-based heart promotion project, which was implemented between and in Wath and Swinton, England. Discussion This study reviews major studies on the economics of tobacco smoking and the economic impact of reducing its prevalence both globally and in UK.
Limitations of the study Only a few studies examining the long-term effect of smoking cessation interventions were found. Conclusions Though tobacco smoking may be economically beneficial, its direct costs and externalities to society far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes eg, a healthy population and a vibrant workforce.
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Jha F, Chaloupka FJ. The economics of global tobacco control. Infographic also available in Azerbaijani. You have clicked on a link to a page that is not part of the beta version of the new worldbank. Will you take two minutes to complete a brief survey that will help us to improve our website? Thank you for agreeing to provide feedback on the new version of worldbank. Thank you for participating in this survey! Your feedback is very helpful to us as we work to improve the site functionality on worldbank.
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