Current and future avoidable cost of smoking--estimates for Sweden 2007

Social Costs of Smoking in the Czech Republic

OBJECTIVES

Smoking is an important risk factor leading to many diseases, which brings substantial healthcare costs as well as indirect costs due to decreased productivity. This article aims to quantify the social costs of smoking in the Czech Republic in 2019.

METHODS

The prevalence-based, cost-of-illness approach is used, which assesses the costs as the sum of direct (healthcare) costs and indirect costs (productivity losses due to mortality and morbidity). The costs of healthcare utilization and pharmacotherapy in direct costs, and the costs of absenteeism, presenteeism, and premature mortality in indirect costs, are included.

RESULTS

Total costs of smoking in the Czech Republic in 2019 are estimated as 2110.6 million EUR (0.94% of GDP). Direct costs amounted to 537.0 million EUR (2.9% of health expenditures in 2019) and indirect costs were 1573.6 million EUR, mainly driven by the costs of premature mortality (1062.5 million EUR).

CONCLUSIONS

Despite the declining trend in the prevalence of smoking in the Czech Republic, the associated costs are considerable. Investments into strategies to reduce smoking continue to be needed.

Lifetime costs and lifetime net public expenditures of smoking

BACKGROUND

Current estimates of lifetime costs of smoking are largely based on model analyses using etiologic fractions for a variety of diseases or Markov chain models. Direct estimation studies based on individual data for health costs by smoking status over a lifetime are non-existent.

METHODS

We estimated lifetime costs in a societal perspective of 18-year-old daily-smokers (continuing smoking throughout adult life) and never-smokers in Denmark, as well as lifetime public expenditures in the two groups. Main outcomes were lifetime net public expenditures and lifetime health costs according to OECD definitions and lifetime earned incomes. Estimates of these outcomes were based on registries containing individual-level data. Confounder-adjusted differences between daily-smokers and never-smokers were interpreted as smoking-attributable lifetime public expenditures and costs.

RESULTS

The net lifetime public expenditure is, on average, €20 520 higher for male 18-year-old daily-smokers than for never-smokers, but €9771 lower, for female daily-smokers compared with never-smokers. In male 18-year-old daily-smokers, average lifetime health costs are €9921 higher and average lifetime earned incomes are €91 159 lower than for never-smokers. The corresponding figures are €5849 higher and €23 928 lower, respectively, for women.

CONCLUSION

18-year-old male daily-smokers are net public spenders over their lifetime compared with never-smokers, while the opposite applies for women. In Denmark, smoking is associated with higher lifetime health costs for society and losses in earned incomes-both for men and women.

Quantifying the social costs and benefits of tobacco in Estonia

BACKGROUND

The tobacco cost literature has predominantly focused on estimating direct healthcare costs and productivity losses from morbidity and mortality. This study places a greater focus on the effects that arise through the fiscal system, illicit trade and fire accidents to estimate the social costs and benefits of tobacco use in Estonia in 2018.

METHODS

A prevalence-based cost-of-illness approach was used, relying on data from the 2017-2018 period. Age-specific tobacco-attributable fractions were employed to estimate the costs and benefits of tobacco-related morbidity and mortality. Data on mortality, morbidity and healthcare costs were received from the National Institute of Health Development and the Estonian Health Insurance Fund. We used data for offences and fires from the Estonian Rescue Board and the Estonian Tax and Customs Board.

RESULTS

It was estimated that the total social cost attributable to tobacco in Estonia in 2018 was €174 million, representing 0.67% of the nation's GDP. If future benefits are also considered, the net social cost is €78 million. While the greatest cost components are productivity losses from mortality and morbidity, the level of tobacco-related law enforcement costs are comparable to direct healthcare costs, both of which exceed €10 million annually.

CONCLUSIONS

Despite the substantial social benefits arising through the fiscal system, tobacco-related costs outweighed these benefits in Estonia in 2018. In addition, a considerable portion of the economic burden of tobacco is associated with illicit trade. Therefore, the healthcare and law enforcement sectors would both benefit from effective tobacco control policies.

The Economic Cost of Smoking in South Africa, 2016

INTRODUCTION

Chronic, noncommunicable diseases are on the rise globally, with tobacco consumption being an important contributing risk factor. These increases result in significant economic costs due to increased healthcare costs, productive lives lost, and productive days lost due to illness. Estimates of these economic costs are scarce in low- and middle-income countries.

METHODS

Drawing on a diverse range of data sources, direct healthcare costs, and productivity losses due to illness and premature deaths were estimated using the cost-of-illness approach. The present value of lifetime earnings was used to estimate productivity losses from premature deaths.

RESULTS

We estimate that 25 708 deaths among persons aged 35-74 in 2016 are smoking-attributable. The economic cost of smoking was R42 billion (US$2.88 billion), of which R14.48 billion was for healthcare costs (hospitalization and outpatient department visits). The economic cost of smoking amounted to 0.97% of the South African GDP in 2016, while the healthcare cost of smoking-related diseases was 4.1% of total South African health expenditure. The costs are lower for women because of their lower smoking prevalence.

CONCLUSION

The economic burden of smoking calls for a further scaling-up of tobacco-control interventions in South Africa.

IMPLICATIONS

This article addresses the paucity of research on the detailed economic costs of smoking in low-and middle-income countries, including South Africa. Our calculations, based on an extensive range of recent data, provide the most detailed estimate to date and include quantification of the direct and indirect costs of smoking in South Africa. We found that the magnitude of the costs related to smoking in South Africa is larger than in the previous estimates and that for every Rand received in the form of cigarette tax, society loses 3.43 Rands. This article provides an economic case for evidence-based tobacco control in South Africa.

Simulating future public health benefits of tobacco control interventions: a systematic review of models

BACKGROUND

To prioritise tobacco control interventions, simulating their health impacts is valuable. We undertook a systematic review of tobacco intervention simulation models to assess model structure and input variations that may render model outputs non-comparable.

METHODS

We applied a Medline search with keywords intersecting modelling and tobacco. Papers were limited to those modelling health outputs (eg, mortality, health-adjusted life years), and at least two of cancer, cardiovascular and respiratory diseases. Data were extracted for each simulation model with ≥3 arising papers, including: model type, untimed or with time steps and trends in business-as-usual (BAU) tobacco prevalence and epidemiology.

RESULTS

Of 1911 papers, 186 met the inclusion criteria, including 13 eligible simulation models. The SimSmoke model had the largest number of publications (n=46), followed by Benefits of Smoking Cessation on Outcomes (n=12) and Tobacco Policy Model (n=10). Two of 13 models only estimated deaths averted, 1 had no time steps, 5 had no future trends in BAU tobacco prevalence, 9 had no future trends in BAU disease epidemiology and 7 had no time lags from quitting tobacco to reversal of health harm.

CONCLUSIONS

Considerable heterogeneity exists in simulation models, making outputs substantively non-comparable between models. Ranking of interventions by one model may be valid. However, this may not be true if, for example, interventions that differentially affect age groups (eg, a tobacco-free generation policy vs increased cessation among adults) do not account for plausible future trends. Greater standardisation of model structures and outputs will allow comparison across models and countries, and for comparisons of the impact of tobacco control interventions with other preventive interventions.

The health cost of tobacco use in Uganda

The economic cost of tobacco use is well documented in high-income countries. It has been measured in relatively fewer low-and middle-income countries, and much less in sub-Saharan Africa despite the longstanding recognition of significant current and future health risk to people attributed by tobacco use in this region. This article fills this gap by estimating the economic cost of tobacco use in Uganda, a low-income country in sub-Saharan Africa. This study estimates the economic cost of tobacco use in Uganda using the cost-of-illnesses approach based on data collected from a survey of patients and caregivers in four major service centers in Mulago National Referral Hospital, namely, Uganda Cancer Institute, Uganda Heart Institute, Chest Clinic and Diabetic Clinic, key informant interviews and secondary sources for the year 2014. The total direct health care and non-health care cost of tobacco-related illnesses in Uganda was USD 41.56 million. The total indirect morbidity and mortality costs from the loss of productivity due to tobacco-related illnesses were USD 11.91 million and USD 73.01 million, respectively. The direct and indirect costs of tobacco use added up to USD 126.48 million, which is equivalent to 0.5% of GDP, a proportion comparable to the estimated health cost of tobacco use in other countries. The total health care cost of tobacco-related illnesses constitutes 2.3% of the national health care account which is already over-burdened with the cost of infectious diseases, limited medical personnel and infrastructure. In addition, tobacco-related illnesses heavily reduce life expectancy of tobacco users and ultimately their economic productivity. The cost of tobacco-related illnesses in Uganda far outweighs the benefits of employment and tax revenue generated from the tobacco sector. Stronger tobacco control measures need to be undertaken to reduce the disease and economic burden of tobacco use in this country.

Smoking is Associated with Higher Disease-related Costs and Lower Health-related Quality of Life in Inflammatory Bowel Disease

BACKGROUND AND AIMS

Smoking affects the course of inflammatory bowel disease [IBD]. We aimed to study the impact of smoking on IBD-specific costs and health-related quality-of-life [HrQoL] among adults with Crohn's disease [CD] and ulcerative colitis [UC].

METHODS

A large cohort of IBD patients was prospectively followed during 1 year using 3-monthly questionnaires on smoking status, health resources, disease activity and HrQoL. Costs were calculated by multiplying used resources with corresponding unit prices. Healthcare costs, patient costs, productivity losses, disease course items and HrQoL were compared between smokers, never-smokers and ex-smokers, adjusted for potential confounders.

RESULTS

In total, 3030 patients [1558 CD, 1054 UC, 418 IBD-unknown] were enrolled; 16% smoked at baseline. In CD, disease course was more severe among smokers. Smoking was associated with > 30% higher annual societal costs in IBD (€7,905 [95% confidence interval €6,234 - €9,864] vs €6,017 [€5,186 - €6,946] in never-smokers and €5,710 [€4,687 - €6,878] in ex-smokers, p = 0.06 and p = 0.04, respectively). In CD, smoking patients generated the highest societal costs, primarily driven by the use of anti-tumour necrosis factor compounds. In UC, societal costs of smoking patients were comparable to those of non-smokers. Societal costs of IBD patients who quitted smoking > 5 years before inclusion were lower than in patients who quitted within the past 5 years (€ 5,135 [95% CI €4,122 - €6,303] vs €9,342 [€6,010 - €12,788], p = 0.01). In both CD and UC, smoking was associated with a lower HrQoL.

CONCLUSIONS

Smoking is associated with higher societal costs and lower HrQoL in IBD patients. Smoking cessation may result in considerably lower societal costs.

Global economic cost of smoking-attributable diseases

Background

The detrimental impact of smoking on health has been widely documented since the 1960s. Numerous studies have also quantified the economic cost that smoking imposes on society. However, these studies have mostly been in high income countries, with limited documentation from developing countries. The aim of this paper is to measure the economic cost of smoking-attributable diseases in countries throughout the world, including in low- and middle-income settings.

Methods

The Cost of Illness approach is used to estimate the economic cost of smoking attributable-diseases in 2012. Under this approach, economic costs are defined as either ‘direct costs' such as hospital fees or ‘indirect costs’ representing the productivity loss from morbidity and mortality. The same method was applied to 152 countries, which had all the necessary data, representing 97% of the world's smokers.

Findings

The amount of healthcare expenditure due to smoking-attributable diseases totalled purchasing power parity (PPP) $467 billion (US$422 billion) in 2012, or 5.7% of global health expenditure. The total economic cost of smoking (from health expenditures and productivity losses together) totalled PPP $1852 billion (US$1436 billion) in 2012, equivalent in magnitude to 1.8% of the world's annual gross domestic product (GDP). Almost 40% of this cost occurred in developing countries, highlighting the substantial burden these countries suffer.

Conclusions

Smoking imposes a heavy economic burden throughout the world, particularly in Europe and North America, where the tobacco epidemic is most advanced. These findings highlight the urgent need for countries to implement stronger tobacco control measures to address these costs.

A Cluster-Randomized Controlled Trial Evaluating the Effectiveness and Cost-Effectiveness of Tobacco Cessation on Prescription in Swedish Primary Health Care: A Protocol of the Motivation 2 Quit (M2Q) Study

Background

In Sweden, the prevalence of tobacco use is disproportionately high among socioeconomically disadvantaged groups. Previous research and clinical experience suggest that prescribed lifestyle interventions in the primary health care (PHC) setting such as Physical Activity on Prescription are effective in changing behavior. However, there is a lack of evidence for if and how such a prescription approach could be effectively transferred into the tobacco cessation context.

Objective

The aim of this trial is to evaluate the effectiveness and cost-effectiveness of Tobacco Cessation on Prescription (TCP) compared to current practice for tobacco cessation targeting socioeconomically disadvantaged groups in the PHC setting in Sweden.

Methods

The design is a pragmatic cluster-randomized controlled trial. The sample will consist of 928 daily tobacco users with Swedish social security numbers and permanent resident permits, recruited from 14-20 PHC centers located in socioeconomically disadvantaged areas in Stockholm County. The primary outcome will be measured in self-reported 7-day abstinence at 6 and 12 months after the intervention. The secondary outcomes will be measured in daily tobacco consumption, number of quit attempts, and health-related quality of life at 6 and 12 months after the intervention. Data will be collected through questionnaires and review of electronic medical records. Cost-effectiveness will be estimated through decision analytic modeling and measured by the incremental cost per quality-adjusted life year.

Results

In the first set of PHC centers participating in the study, eight centers have been included. Recruitment of individual study participants is currently ongoing. Inclusion of a second set of PHC centers is ongoing with expected study start in September 2016.

Conclusions

If TCP is found effective and cost-effective compared to standard treatment, the method could be implemented to facilitate tobacco cessation for socioeconomically disadvantaged groups in the PHC setting in Sweden.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 11498135; http://www.isrctn.com/ISRCTN11498135 (Archived by WebCite at http://www.webcitation.org/6kTu6giYQ)

Mathematical Modeling in Tobacco Control Research: Initial Results From a Systematic Review

OBJECTIVES

The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models.

METHODS

We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies.

RESULTS

The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies.

CONCLUSIONS

This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work.

Epilepsy in Sweden: health care costs and loss of productivity--a register-based approach

PURPOSE

The objective was to estimate health care costs and productivity losses due to epilepsy in Sweden and to compare these estimates to previously published estimates.

METHODS

Register data on health care utilisation, pharmaceutical sales, permanent disability and mortality were used to calculate health care costs and costs that accrue due to productivity losses. By linkage of register information, we were able to distinguish pharmaceuticals prescribed against epilepsy from prescriptions that were prompted by other indications.

RESULTS

The estimated total cost of epilepsy in Sweden in 2009 was <euro>441 million, which corresponds to an annual per-patient cost of <euro>8,275. Health care accounted for about 16% of the estimated total cost, and drug costs accounted for about 7% of the total cost. The estimated health care cost corresponded to about 0.2% of the total health care cost in Sweden in 2009. Indirect costs were estimated at <euro>370 million, 84% of which was due to sickness absenteeism. Costs resulting from epilepsy-attributable premature deaths or permanent disability to work accounted for about 1% of the total indirect cost in Sweden in 2009.

DISCUSSION

The per-patient cost of epilepsy is substantial. Thus, even though the prevalence of the illness is relatively small, the aggregated cost that epilepsy incurs on society is significant.