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Chapter 4 Estimating the Cost of Tobacco Use James Lightwood, David Collins, Helen Lapsley, and Thomas E. Novotny Reliable
estimates of the costs of tobacco use are valuable to
policy-makers, particularly in planning health service
provision and other items of public expenditure. However,
such estimates are difficult to obtain because the methods
used by different researchers vary and, in some respects,
are controversial. Four types of cost analyses are compared
here and the implications of different methods for results
are explored. The literature on the healthcare costs of
smoking is more extensive than for other types of cost and
therefore forms the focus of this chapter. Estimates of the
gross healthcare costs of smoking (that is, all the
expenditures associated with treating diseases attributable
to smoking) for high-income countries range between 0.10%
and 1.1% of gross domestic product (GDP). The higher
estimates occur in countries where healthcare costs account
for a relatively large share of GDP. In low-income and
middle-income countries, fewer studies have been performed,
and often with very limited data, but the existing studies
suggest that the gross costs of smoking can be as high as
those in high-income countries. Studies of the net
healthcare costs of smoking - which compare the
lifetime healthcare costs of smokers and non-smokers
and take account of the fact that smokers' lives are usually
shorter than non-smokers' - reach more heterogeneous
conclusions. This is because of major variations in the
methods and assumptions used. However, the majority of these
studies indicate that there are net costs from smoking.
There is a clear need for refinement of the methods for
making cost estimates, particularly for application in
developing countries where the tobacco epidemic has yet to
peak.
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