Ke. Warner et al., Medical costs of smoking in the United States: estimates, their validity, and their-implications, TOB CONTROL, 8(3), 1999, pp. 290-300
Citations number
42
Categorie Soggetti
Public Health & Health Care Science","Envirnomentale Medicine & Public Health
Objective-To compare estimates of the medical costs of smoking in the Unite
d States and to consider their relevance to assessing the costs of smoking
in developing countries and the net economic burden of smoking.
Data sources-A Medline search through early 1999 using keywords "smoking" a
nd "cost", with review of article reference lists.
Study selection-Peer-reviewed papers examining medical costs in a single ye
ar, covering the non-institutionalised American population.
Data extraction-Methods underlying study estimates were identified, describ
ed, and compared with attributable expenditure methodology in the literatur
e dealing with costs of illness. Differences ins methods were associated wi
th implied differences in findings.
Data synthesis-With one exception, the studies find the annual medical cost
s of smoking to constitute approximately 6-8% of American personal health e
xpenditures. The exception, a recent study, found much larger attributable
expenditures. The lower estimates may reflect the limitation of analysis to
costs associated with the principal smoking-related diseases. The higher e
stimate derives from analysis of smoking-attributable differences in all me
dical costs. However, the finding from the most recent study, also consider
ing all medical costs, fell in the 6-8% range.
Conclusions-The medical costs of smoking in the United States equal, and ma
y well exceed, the commonly referenced figure of 6-8%. This literature has
direct methodological relevance to developing countries interested in asses
sing the magnitude of their current cost-of-smoking burden and their future
burdens, with differences in tobacco use histories and the availability of
chronic disease treatment affecting country-specific estimates. The debate
over the use of gross or net medical cost estimates is likely to intensify
with the proliferation of lawsuits against the tobacco industry to recover
expenditures on tobacco-produced disease.