In addition, costs of medical treatment of tobacco-related diseases in seven hospitals in Moldova during 2016 were obtained. These costs were identified from the Diagnosis Related Group (DRG) database based on the following ICD-10<sup>9</sup> codes:

1. Malignant neoplasms, including lip, oral cavity, pharynx, esophagus, stomach, larynx, trachea, lungs and bronchial tubes, kidneys, bladder and pancreases (C00-C14, C15-C26, C30-C39, C64-C68);

2. Cardiovascular diseases, including ischemic heart disease, other heart diseases, hypertension, cerebrovascular diseases and other CVD (I10-115, I20-125, I30-152, I60-169); 3. Respiratory diseases, including influenza and pneumonia, other acute lower respiratory diseases and chronic obstructive pulmonary disease (J10-J18, J20-J22, J40-J47).

This data are based on a costing exercise currently underway, which was completed for seven pilot hospitals and represent aproximtely 20 percent of total patients treated in Moldova for 2016. Hospitals covered in our case represent tertiary and secondary level of care: Oncology Institute, Emergency Hospital, Neurology Institute, Republican Clinical Hospital, Holly Trinity Hospital, Cahul Raion Hospital).

**Table 6 – Tobacco Related Medical Costs in Seven Hospitals in Moldova**

|_Disease_|_Treatment cost, Moldova_<br>_(USD$)_|_Number Sample_|_Tobacco Related_<br>_Cases_|_Total Estimated_<br>_Cost_|
|---|---|---|---|---|
|Cardiovascular disease|762|1525|16,760|12,771,120|
|Cancer|352|327|3,977|1,399,904|
|Pneumonia and respiratory diseases|657|169|852|559,764|
|<br>Total||||14,730,788|

* ICD-10: Cardiovascular diseases (CVD): including ischemic heart disease, other heart diseases, hypertension, cerebrovascular diseases and other CVD (I10-115, I20-125, I30-152, I60-169); Number of cases survey= 1525

** ICD-10: Malignant neoplasms, including lip, oral cavity, pharynx, esophagus, stomach, larynx, trachea, lungs and bronchial tubes, kidneys, bladder and pancreases  (C00-C14, C15-C26, C30-C39, C64-C68); Number of cases survey= 327 *** ICD-10: Respiratory diseases, including influenza and pneumonia, other acute lower respiratory diseases and chronic obstructive pulmonary disebase (J10-J18, J20-J22, J40-J47); Number of cases survey= 169

By comparing the estimated treatment costs presented in tables 5 and 6, it is possible to assess that the survey shows higher costs for cardiovascular diseases and pneumonia and respiratory diseases, but lower cost estimates for cancers and malignant neoplasms. The higher cost of pneumonia and respiratory diseases from the survey can be explained due to the fact that these hospitals are tertiary and secondary level care, therefore they attend patients with complex and advanced cases. Therefore, this would be a more appropriate cost measure for diseases associated with tobacco related to mortality. The total cost associated with these estimations is US$14.7 million, higher than the US$10.2 million previously estimated. In the following, the analysis will take the upper bound cost estimates; however, the results using the lower bound do not change much and are presented on Annex IV.

# **Descriptive Statistics**

The study used the household budget survey to estimate the cost of an increase in tobacco taxes. Table 7 summarizes the most important indicators, including the total monthly expenditure of households in Moldova.

> 9 International Statistical Classification of Diseases and Related Health Problems (ICD), ICD-10, refers to the tenth revision.

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