The cost to society of smoking cessation (1998)

Background. Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs at advanced ages. We analyzed health care costs for smokers and nonsmokers and estimated the economic consequences of smoking cessation. Methods. We used three life tables to examine the effect of smoking on health care costs-one for a mixed population of smokers and nonsmokers, one for a population of smokers, and one for a population of nonsmokers. We also used a dynamic method to estimate the effects of smoking cessation on health care costs over time. Results. Health care costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers, but in a population in which no one smoked the costs would be 7 percent higher among men and 4 percent higher among women than the costs in the current mixed population of smokers and nonsmokers. If all smokers quit, health care costs would be lower at first, but after 15 years they would become higher than at present. In the long term, complete smoking cessation would produce a net increase in health care costs, but it could still be seen as economically favorable under reasonable assumptions of discount rate and evaluation period. Conclusions. If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs. (N Engl J Med 1997;337:1052-7) Smoking related diseases cost the British National or not smokers impose a net financial burden ought to be of very limited importance" (page 1057). A more Health Service (NHS) somewhere between 1.4 billion and 1.7 billion every year. 1 It is hardly surprising, appropriate health policy objective is to increase life years and improve health related quality of life. What therefore, that reductions in these health care costs should be highlighted as a major benefit of smoking matters, therefore, is how the cost of achieving these health gains through smoking cessation interventions cessation. However, non-smokers live longer than smokers. In the USA 78% of male non-smokers are still compares with the cost of achieving them by other means. alive at the age of 70 compared with 57% of smokers. At the age of 80 the figures are 50% and 21%, respectively. 2 It was not the intention of the Barendregt study, nor is it the intention of the present review, to address that Non-smokers thus impose a greater burden on health care resources in old age than their shorter lived fellow question. Reviews of the cost effectiveness of smoking cessation are available elsewhere. 3 4 Here, the focus is citizens who smoke. This has led to much recent research into who has the greater lifetime health care costs, the on the cost to society of smoking cessation. We shall address this by critically examining the approach and smoker or the non-smoker? In the introductory article Barendregt and colleagues conclude that, despite the assumptions of the Barendregt study with respect to health care costs of smoking, and by considering the short term savings to society from smokers quitting, the long term effect will be a net increase in health care wider economic implications of changing smoking habits, since the financial costs of smoking are not confined costs. 2 The public health policy implications of this con-to health service resource use. clusion require several additional issues to be addressed, including the key question-so what? Barendregt and colleagues quite rightly point out that the primary ob-Does the introductory article underestimate the health care costs of smoking? jective of health policy is not to save money, and therefore evaluation of policy measures cannot be on the The estimate which Barendregt and colleagues provide for the lifetime health care costs of smokers and non-basis of whether or not they produce net resource savings: ". . . in formulating public health policy, whether smokers is based on the incidence, prevalence, and on July 12, 2023 by guest.