So much for the bogus "preventive care saves money" argument...
The New England Journal of Medicine
The Health Care Costs of Smoking
Jan J. Barendregt, M.A., Luc Bonneux, M.D., and Paul J. van der Maas, Ph.D.
ABSTRACT
Background Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs at advanced ages. We analyzed health care costs for smokers and nonsmokers and estimated the economic consequences of smoking cessation.
Methods We used three life tables to examine the effect of smoking on health care costs — one for a mixed population of smokers and nonsmokers, one for a population of smokers, and one for a population of nonsmokers. We also used a dynamic method to estimate the effects of smoking cessation on health care costs over time.
Results Health care costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers, but in a population in which no one smoked the costs would be 7 percent higher among men and 4 percent higher among women than the costs in the current mixed population of smokers and nonsmokers. If all smokers quit, health care costs would be lower at first, but after 15 years they would become higher than at present. In the long term, complete smoking cessation would produce a net increase in health care costs, but it could still be seen as economically favorable under reasonable assumptions of discount rate and evaluation period.
Conclusions If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs.
Smoking is a major health hazard, and since nonsmokers are healthier than smokers, it seems only natural that not smoking would save money spent on health care. Yet in economic studies of health care it has been difficult to determine who uses more dollars — smokers, who tend to suffer more from a large variety of diseases, or nonsmokers, who can accumulate more health care costs because they live longer. The Surgeon General reported in 1992 that "the estimated average lifetime medical costs for a smoker exceed those for a nonsmoker by more than $6,000."1 On the other hand, Lippiatt estimated that a 1 percent decline in cigarette sales increases costs for medical care by $405 million among persons 25 to 79 years old.2 Manning et al. argued that although smokers incur higher medical costs, these are balanced by tobacco taxes and by smokers' shorter life spans (and hence their lower use of pensions and nursing homes).3 Leu and Schaub showed that even when only health care expenditures are considered, the longer life expectancy of nonsmokers more than offsets their lower annual expenditures.4
We have analyzed comprehensively the health care costs of smoking. In doing so we have distinguished between the assessment of differences between smokers and nonsmokers and the assessment of what would happen after interventions that changed smoking behavior. Would a nonsmoking population have lower health care costs than one in which some people smoke? Are antismoking interventions economically attractive? We sought to answer these questions and to determine the consequences for health policy.
World Health Organ 1994;72:663-674. [Medline]
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