**Table 4. Tobacco-Related Deaths**

|_Age-group_|_Ischemic disease_|_Stroke_|_Other cardiovascular diseases_|_COPD_|_Other respiratory diseases_|_Lung cancer_|_Other cancers_|_Other causes_|
|---|---|---|---|---|---|---|---|---|
|0−1|-|23|50|-|49|-|143|4,299|
|1−4|-|1|13|-|112|-|62|739|
|5−14|-|8|20|-|171|4|25|851|
|15−24|128|66|182|14|438|9|138|4,930|
|25−34|718|288|964|43|1,251|54|704|13,528|
|35−54|13,472|5,585|7,056|2,244|13,989|691|2,757|42,064|
|55−74|118,364|37,654|12,794|9,586|43,274|5,553|2,132|33,808|
|75+|181,987|57,724|27,992|2,289|15,306|6,441|767|24,653|
|Total|314,669|101,349|49,071|14,176|74,590|12,752|6,728|124,872|

_Source:_ Calculations using data of Denisova and Kuznetsova 2014. _Note:_ COPD = chronic obstructive pulmonary disease.

# **d. Cost of treatment**

To estimate the medical costs of tobacco consumption, tobacco-related medical treatments and deaths are examined. The Ukrainian Department of Health Statistics and Information provides information on mortality related to tobacco consumption for 2013. As a second source of information, the total number of tobaccorelated events are also obtained from Denisova and Kuznetsova (2014) (see table 4).<sup>13</sup> Once the estimates of the number of deaths and the incidence of other events have been calculated, we investigate the medical treatment costs for each of these diseases. Table 5 shows estimates of the average cost of medical treatment for tobacco-related diseases in Ukraine. These expenses refer to the cost of treatment incurred by the state and exclude the costs to users. Although Ukraine has an extensive public health care system, not all medical costs are covered by the state. According to the National Health Accounts of Ukraine in 2015, out-of-pocket expenses accounted for 40.5 percent of all medical costs in Ukraine. This cost is covered directly by user expenditures. These costs usually consist of the inputs, medicines, and pharmaceutical components of the treatment. The estimate of the cost of treatment of these diseases therefore includes outof-pocket expenditures calculated at 40.5 percent of the total expenditure.

**Table 5. Cost of Medical Treatments Per Case**

|_Disease_|_Tobacco-related morbidity,_<br>_men, %_|_Tobacco-related morbidity_<br>_women, %_|_Governmental cost, US$_|_Out-of-pocket cost, US$_|
|---|---|---|---|---|
|Ischemic heart disease|24|2|584|389|
|Stroke|25|2|684|456|
|Other cardiovascular diseases|25|2|438|292|
|Respiratory diseases (COPD)|56|17|244|163|
|Lung cancer|91|27|633|422|
|Other cancers|44|3|633|422|

_Sources:_ Calculations using data of Denisova and Kuznetsova 2014. For tuberculosis WHO 2004; Vasalal et al. 2008.[53] _Note:_ US$1.00 = Hrv 8 for years 2013. COPD = chronic obstructive pulmonary disease Table 6 shows the annual medical costs of tobacco-related mortality. The results are taken from calculations based on the data in tables 4 and 5. After calculating the costs related to diseases, the cost of the treatment of illnesses that are related to tobacco consumption are calculated (table 7). Cardiovascular diseases, cardiovascular

> 13 Although determining the exact cause of each particular disease is not possible, the medical community has agreed on the probabilities of disease occurrence by age, gender, and tobacco consumption. The resulting tables of probabilities, along with tobacco incidence, are used to estimate the deaths related to tobacco.

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