Smoking-attributable Costs Research Articles

Smoking-Attributable Doctor Visits and Emergency Room Utilization and Costs by California’s Lesbian, Gay, and Bisexual Community

ABSTRACT The lesbian, gay, and bisexual (LGB) community is known to smoke at greater rates than the general population, but there has been no study estimating the impact of cigarette smoking on healthcare utilization and costs in the LGB population. Using data from the 2005–2014 California Health Interview Surveys, we determine smoking-attributable healthcare utilization and costs among California’s LGB-identified community. Our findings indicate that lesbian/bisexual women who smoke incur excess doctor visits and emergency room visits compared to their never smoking counterparts. No statistically significant differences were found for gay/bisexual men. Annual smoking-attributable costs were $58.3 million for the California LGB community (2019 dollars).

The Economic Burden of Smoking-Attribution and Years of Life Lost due to Chronic Diseases in Mashhad, 2015-2016.

Background:Tobacco smoking is one of the most preventable causes of mortality related to noncommunicable diseases (NCDs). This study aimed to estimate the direct economic burden and years of life lost (YLL) attributable to smoking in NCDs in Mashhad, 2015–2016.Methods:Hospital-based data were utilized to calculate the economic burden of four selected diseases related to smoking. An epidemiological population-attributable risk method was used to determine the smoking-attributable fraction (SAF). Moreover, the study was conducted by data related to disease-specific expenditures and patients' information on cost and the number of mortality for estimating the YLL for each disease, population and life expectancy data, the prevalence of smoking, and the relative risk of smoking. Data analysis was performed with STATA software, version 12.Results:The total costs attributable to smoking for stroke, myocardial infarction, chronic obstructive pulmonary disease (COPD), and lung cancer were 94148, 151272, 1191396, and 574784 US Dollars, respectively (per 100000). In 2015, the YLL per deaths due to COPD were 4217 and 3522 among males and females, respectively. Furthermore, in 2016, the YLL per deaths due to the stroke in males and females were 8317 and 7563, respectively. In the same year, the highest proportion of years of potential life lost per 100000 smoking-attributable deaths belonged to COPD.Conclusions:The results of this study can be used to inform policy-makers about smoking-attributable diseases in Iran. To decrease the smoking-attributable costs, which have resulted in the spread of NCDs, policy-makers should adopt and implement effective policies regarding smoking prevention and control.

Economic evaluation of smoking cessation in Ontario's regional cancer programs.

Quitting smoking after a diagnosis of cancer results in greater response to treatment and decreased risk of disease recurrence and second primary cancers. The objective of this study was to evaluate the potential cost‐effectiveness of two smoking cessation approaches: the current basic smoking cessation program consisting of screening for tobacco use, advice, and referral; and a best practice smoking cessation program that includes the current basic program with the addition of pharmacological therapy, counseling, and follow‐up. A Markov model was constructed that followed 65‐year‐old smokers with cancer over a lifetime horizon. Transition probabilities and mortality estimates were obtained from the published literature. Costs were obtained from standard costing sources in Ontario and reports. Probabilistic and deterministic sensitivity analyses were conducted to address parameter uncertainties. For smokers with cancer, the best practice smoking cessation program was more effective and more costly than the basic smoking cessation program. The incremental cost‐effectiveness ratio of the best practice smoking cessation program compared to the basic smoking cessation program was $3367 per QALY gained and $5050 per LY gained for males, and $2050 per QALY gained and $4100 per LY gained for females. Results were most sensitive to the hazard ratio of mortality for former and current smokers, the probability of quitting smoking through participation in the program and smoking‐attributable costs. The study results suggested that a best practice smoking cessation program could be a cost‐effective option. These findings can support and guide implementation of smoking cessation programs.

A cost-benefit analysis of smoking cessation prescription coverage from a US payer perspective.

IntroductionSmoking drives substantial direct health care spending, comprising 8.7% ($168 billion) of annual United States aggregated spending. Smoking cessation (SC) prescription use is an effective strategy to improve health outcomes, increase quit rates, and reduce economic burden. However, patient out-of-pocket costs may limit the use. Health care payers play a vital role in driving use through formulary decisions and copayment policies but must consider both the near-term financial investment as well as downstream effects of increased coverage on health care budgets. This study estimates the return on investment (ROI) of providing Affordable Care Act (ACA)-recommended prescription SC coverage.MethodsA cost–benefit analysis (CBA) estimates the ROI of providing prescription SC coverage, based on pharmacy costs and savings from smoking-attributable medical expenditures among Medicare, Medicaid, and commercial plan enrollees over 10 years. The CBA incorporated national-level population demographics, smoking prevalence estimates, proportion of smokers attempting to quit, and the utilization of SC products. A five-state Markov chain model simulated patterns of quit attempts, relapse, and cessation assuming two quit attempts per year, no patient cost-sharing, and 25.4% utilization of prescription SC aids. Results include number of quitters, annual pharmacy and smoking-attributable medical costs, and ROI.ResultsAfter initial investment in SC treatment, smoking-attributable medical benefits accrue over time, generating a positive ROI by year 4 for commercial (11.3%) and Medicaid (78.4%) plans and by year 3 for Medicare (30.6%). Over 10 years, an average return of $1.18, $2.50, and $3.22 savings per dollar spent on SC prescriptions for commercial, Medicaid, and Medicare plans, respectively, may be realized.DiscussionGiven the proven efficacy of SC pharmacotherapy, near-term investments in supporting ACA-recommended SC coverage translate into a positive ROI. As smoking is a leading cause of morbidity and mortality, increased access to prescription SC medications may improve health outcomes and reduce smoking-attributable costs to payers over time.

Prevalence-based, disease-specific estimate of the social cost of smoking in Singapore

ObjectiveTo estimate the cost of smoking in Singapore in 2014 from the societal perspective.MethodsA prevalence-based, disease-specific approach was undertaken to estimate the smoking-attributable costs. These include direct and indirect costs...

Economic Burden of Smoking in Iran: A Prevalence-Based Annual Cost Approach

Objectives:The burden of smoking on the health system and society is significant. The current study aimed to estimate the annual direct and indirect costs of smoking in Iran for the year 2014.Methods:A prevalence-based disease-specific approach was used to determine costs associated with the three most common smoking-related diseases: lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD). Data on healthcare utilization were obtained from an original survey, hospital records and questionnaires. The number of deaths was extracted from the global burden diseases study (GBD). The human capital approach was applied to estimate the costs of morbidity and mortality due to smoking-related diseases, classified as direct (hospitalization, outpatients and non-medical costs) and indirect (mortality and morbidity).Results:The total economic cost of the three most common smoking-attributable diseases in Iran was US$1.46 billion in 2014, including US$1.05 billion (71.7%) in indirect and US$0.41 billion (28.3%) in direct costs. Direct costs of the three smoking-related diseases accounted for 1.6% of total healthcare expenditures and total costs were about 0.26% of Iran’s gross domestic product (GDP) in 2014.Conclusions:Our study indicated that smoking places a substantial economic burden on Iranian society. Therefore, sustained smoking cessation interventions and tobacco control policies are required to reduce the magnitude and extent of smoking-attributable costs in Iran.

Annual healthcare spending attributable to cigarette smoking: an update.

Fifty years after the first Surgeon General's report, tobacco use remains the nation's leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking-attributable costs in the U.S. To update annual smoking-attributable healthcare spending in the U.S. and provide smoking-attributable healthcare spending estimates by payer (e.g., Medicare, Medicaid, private insurance) or type of medical services. Analyses used data from the 2006-2010 Medical Expenditure Panel Survey linked to the 2004-2009 National Health Interview Survey. Estimates from two-part models were combined to predict the share of annual healthcare spending that could be attributable to cigarette smoking. The analysis was conducted in 2013. By 2010, 8.7% (95% CI=6.8%, 11.2%) of annual healthcare spending in the U.S. could be attributed to cigarette smoking, amounting to as much as $170 billion per year. More than 60% of the attributable spending was paid by public programs, including Medicare, other federally sponsored programs, or Medicaid. These findings indicate that comprehensive tobacco control programs and policies are still needed to continue progress toward ending the tobacco epidemic in the U.S. 50 years after the release of the first Surgeon General's report on smoking and health.

Health care expenditures attributable to smoking in military veterans.

The health effects of cigarette smoking have been estimated to account for between 6%-8% of U.S. health care expenditures. We estimated Veterans Health Administration (VHA) health care costs attributable to cigarette smoking. VHA survey and administrative data provided the number of Veteran enrollees, current and former smoking prevalence, and the cost of 4 types of care for groups defined by age, gender, and region. Cost and smoking status could not be linked at the enrollee level, so we used smoking attributable fractions estimated in sample of U.S. residents where the linkage could be made. The 7.7 million Veterans enrolled in VHA received $40.2 billion in VHA provided health services in 2010. We estimated that $2.7 billion in VHA costs were attributable to the health effects of smoking. This was 7.6% of the $35.3 billion spent on the types of care for which smoking-attributable fractions could be determined. The fraction of inpatient costs that was attributable to smoking (11.4%) was greater than the fraction of ambulatory care cost attributable to smoking (5.3%). More cost was attributable to current smokers ($1.7 billion) than to former smokers ($983 million). The fraction of VHA costs attributable to smoking is similar to that of other health care systems. Smoking among Veterans is slowly decreasing, but prevalence remains high in Veterans with psychiatric and substance use disorders, and in younger and female Veterans. VHA has adopted a number of smoking cessation programs that have the potential for reducing future smoking-attributable costs.

Current and future avoidable cost of smoking – Estimates for Sweden 2007

Objective To estimate current and future avoidable smoking-attributable costs in Sweden for the year 2007. Design Disease specific smoking-attributable proportions were calculated for Swedish smoking patterns and applied to estimate costs for smoking-related diseases based on data from public registers. Avoidable future effects of smoking were calculated employing a Markov simulation model. Results The estimated total cost in 2007 was USD 1.6 billion, or USD 181 per capita. Healthcare (direct) cost accounted for 30% of the total cost. The number of deaths was 97 per 100,000 inhabitants (79 in 2001); the number of years of potential life lost 1,227 per 100,000 inhabitants (1012 in 2001); and the number of years of potential productive life lost 226 (185 in 2001) per 100,000 inhabitants. Avoidable future lifetime costs, per 100,000 inhabitants, amounted to USD 19 million (healthcare), 14,000 years of potential life lost, corresponding to a present value of USD 158 million. Total avoidable cost of current smoking amounted to USD 16 billion. Conclusion In spite of declining smoking-prevalence rates during the last 30 years, smoking-attributable deaths increased between 2001 and 2007. The number of life years lost per death decreased somewhat, indicating that the age distribution of those dying shifted further towards older age. Simulations indicate that smoking-cessation among young smokers yields considerable more benefits each year than smoking-cessation among older smokers. The health benefits that accrued in 2007, as a result of declining smoking prevalence since 1980, correspond to more than the total cost of smoking in that year.

The costs of smoking in Vietnam: the case of inpatient care

Objective:To estimate the social costs of smoking related to inpatient care in Vietnam using 2005 data.Design:The cost of illness as a result of hospitalisation for three major smoking-related diseases combined...

Tobacco attributable morbidity and hospital costs in Piedmont: forecast for the years 2003-2014

Background: Tobacco smoke is the main cause of mortality and morbidity in most industrialized countries. The aim of this study is to forecast the smoke-related morbidity for the residents in Piedmont for the years 2003-2014 and the relative costs for the regional health service, using as an indicator the number of hospital admissions caused by smoke and as an instrument the DRG rates. Methods: The model uses the risk of hospitalisation among non smokers to predict smoke related morbidity for the period 2003-2014 for both smokers and ex-smokers, by using relative risks (RRs) and smoking prevalence. It should be noted that, because of the 15-year latency between smoke exposure and health outcomes, smoking prevalence of the appropriate time period has been applied to the morbidity data of the following 15 years, thus because of the shift of birth cohorts we are able to make forecasts up until the year 2014. Basing on these data it is possible estimate, separately for smokers and ex-smokers, the aetiological fraction (PAR%) used to estimate smoking attributable admissions and smoking attributable costs. The costs attributable to admissions for smoke-related diseases have been estimated using prices set for 2002 as well as prices adjusted for inflation. Results: A total of 145801 hospitalizations are expected among men and 36959 among females for the period 2003-2014. The economic value of the attributable admissions, at prices adjusted for inflation, increases in the period 2003-2014 with a slowdown in 2014. Data show that in 2014, compared to 2003, a smaller amount of resources, in true value, have been allocated to smoking related admissions (- 11.08%). Conclusions. The model used meta-analytic RR real prevalence data, considering a fifteen-year latency period between exposure and its effect on health. Furthermore, an economic estimate is made for each DRG instead of applying medium rates for Major Diagnostic Categories as is frequently seen at a national level.

Mortality, morbidity and costs attributable to smoking in Germany: update and a 10-year comparison

Objective: To assess the negative health consequences and associated costs of cigarette smoking in Germany in 2003 and to compare them with the respective results from 1993. Methods: The number...

Birth and first-year costs for mothers and infants attributable to maternal smoking

Maternal smoking during pregnancy has been linked to high costs. This study estimates the magnitude of excess costs attributable to smoking during pregnancy for mothers and infants. The model estimates smoking-attributable costs for 11 infant and maternal conditions. From a claims database of 7784 mothers and 7901 infants who had deliveries during 1996, we estimated total cost over the infants' first year of life for each mother and infant and identified each complication of interest, based on ICD-9 codes. The average cost for smokers and non-smokers could not be computed directly because smoking status is not available in claims data. Therefore, the population attributable risk percentage (PAR%) due to smoking for each complication was identified from the literature. Multiple linear regression was used to provide estimates of the incremental cost associated with each smoking-related complication. The total cost attributable to smoking was computed as a function of the incremental cost of each complication and the PAR% for each complication. The conditions associated with the largest incremental costs compared to patients without those conditions were abruptio placenta ($23,697) and respiratory distress syndrome ($21,944). Because they were more common, the conditions with the largest smoking-attributable cost were low birth weight ($914) and lower respiratory infection ($428). The sum of the additional costs attributable to smoking for all conditions yielded a total in the first year after birth ranging from $1142 to $1358 per smoking pregnant woman. It was concluded that maternal smoking during pregnancy results in an economic burden to payers and society. These estimates may be useful in formal cost-effectiveness evaluations of individual smoking cessation strategies.

Costs of smoking: a focus on maternal, childhood, and other short-run costs.

Estimating the costs attributable to smoking is helpful for evaluating appropriate tax policy, informing both public and private managers of health care, and evaluating alternative smoking cessation programs. While the smoking-attributable costs of chronic conditions have been well studied, these costs are less relevant to health maintenance organizations (HMOs) and employers whose populations are younger and transient. Costs incurred in the short run, such as those related to smoking during pregnancy and environmental tobacco smoke exposure (ETS) of children, are more relevant. In this article, the authors review studies of these sources of smoking-attributable costs as well as studies that focus on smoking-attributable outcomes and costs from the employer or HMO perspective. Subsidies may be necessary to induce employers to recognize the full social benefits of smoking cessation programs.

Economic costs of substance abuse, 1995.

Substance abuse causes illness and disease, results in high use of medical and other services and high productivity losses, and imposes a multibillion-dollar burden on the economy each year. This article presents estimates of the economic burden of alcohol and drug abuse and smoking in 1995. Included are the direct medical care expenditures and indirect costs and the value of lost productivity for people who are ill and disabled and for people who die prematurely due to substance abuse. The methodology for the cost of alcohol and drug abuse is based on a study conducted by the Lewin Group in 1998 and prepared for the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. The smoking-attributable costs are based on a published study conducted by the author and her colleagues at University of California-Berkeley and at University of California-San Francisco for 1993 and updated to 1995. The total economic costs of substance abuse are estimated at $428.1 billion in 1995: alcohol abuse at $175.9 billion, drug abuse at $114.2 billion, and smoking at $138 billion. The distribution by type of cost varies among the three types of disorders, reflecting differences in the prevalence of these disorders, medical care use, morbidity and mortality patterns, and other related costs for each disorder. Effective interventions must be found to prevent and ameliorate the adverse health consequences of substance abuse, thereby reducing the future high costs of alcohol and drug abuse and smoking.

Smoking-attributable medical care costs in the USA

Medical care costs attributable to cigarette smoking are estimated using an econometric model of annual individual expenditures for four types of medical services: ambulatory, hospital, prescription drug, and other (which includes home health and durable medical equipment and excludes dental and mental health). The model follows the two-part specification of Duan et al. (1983). Estimation is carried out using the 1987 National Medical Expenditure Survey. Fitted values are used to calculate smoking-attributable fractions (SAFs) of expense by type of service and by age and gender category. The overall weighted average SAF is 6.54%. SAFs are generally largest for ambulatory and smallest for hospital expenses. They are larger for males and for the older age categories. The model is analyzed for heteroscedasticity and goodness of fit. Additional analysis using the National Health Interview Survey is conducted to test for the possible effect of not being able to include alcohol consumption in the primary model. A balanced repeated replication analysis is conducted to evaluate the variance of the SAFs. Variances are found to be acceptably small. An extension of the model to support evaluation of smoking-attributable costs for special populations such as individual states, and special insurance pools such as Medicaid recipients, is described. Results for the fifty states are presented. Conclusions and subjects for further research are discussed.

Costs of maternal conditions attributable to smoking during pregnancy

Context: Despite known adverse health effects, many women continue to smoke during pregnancy. Public attention has now focused on the economic as well as health effects of this behavior. Objective: To estimate health care costs associated with smoking-attributable cases of placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), pre-eclampsia, and spontaneous abortion. Design: Pooled odds ratios were used with data on total cases to estimate smoking-attributable cases. Estimated average costs for cases of ectopic pregnancy and spontaneous abortion were used to estimate smoking-attributable health care costs for these conditions. Incremental costs, or costs above those for a “normal” delivery, were used to estimate smoking-attributable costs of placenta previa, abruptio placenta, PPROM, and pre-eclampsia associated with delivery. Setting: National estimates for 1993. Participants: Data from the National Hospital Discharge Survey (NHDS) and claims data from a sample of large, self-insured employers across the country. Results: Smoking-attributable costs ranged from $1.3 million for PPROM to $86 million for ectopic pregnancy. Smoking during pregnancy apparently protects against pre-eclampsia and saves between $36 and $49 million, depending on smoking prevalence. Over all conditions smoking-attributable costs ranged from $135 to $167 million. Conclusions: Smoking during pregnancy is a preventable cause of higher health care costs for the conditions studied. While smoking during pregnancy was found to be protective against pre-eclampsia and, hence, saves costs, the net costs were still positive and significant. Effective smoking-cessation programs can reduce health care costs but clinicians will perhaps need to manage increased cases of pre-eclampsia in a cost-effective manner.

Medical-Care Expenditures Attributable to Cigarette Smoking During Pregnancy—United States, 1995

An estimated 26% of women of reproductive age (i.e., 18-44 years) smoked in 1993, and approximately 19%-27% of women smoke during pregnancy. Smoking during pregnancy is causally associated with an annual estimated 32,000-61,000 low-birthweight infants and 14,000-26,000 admissions to neonatal intensive-care units. The estimated smoking-attributable direct medical-care costs for chronic conditions in 1993 were $50.0 billion; however, this estimate omitted the direct medical costs of tobacco exposure for infants and children and most of these costs for pregnant women. To derive 1995 estimates of the smoking-attributable costs for direct medical expenditures (i.e., inpatient, physician, hospital outpatient, and emergency department costs) related to pregnancy outcomes, the University of California at Berkeley and CDC analyzed data from the 1987 National Medical Expenditures Survey (NMES-2). This report summarizes the findings, which indicate substantial smoking-attributable direct medical expenditures for pregnant women and newborns.

Medical-Care Expenditures Attributable to Cigarette Smoking—United States, 1993

Cigarette smoking is the most important preventable cause of morbidity and premature mortality in the United States; however, approximately 48 million persons aged > or = 18 years are smokers (1), and approximately 24 billion packages of cigarettes are purchased annually (2). Each year, approximately 400,000 deaths in the United States are attributed to cigarette smoking (3) and costs associated with morbidity attributable to smoking are substantial (4). To provide estimates for 1993 of smoking-attributable costs for selected categories of direct medical-care expenditures (i.e., prescription drugs, hospitalizations, physician care, home-health care, and nursing-home care), the University of California and CDC analyzed data from the 1987 National Medical Expenditures Survey (NMES-2) and from the Health Care Financing Administration (HCFA). This report summarizes the results of the analysis.