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Tob Control. Sep 1999; 8(3): 290–300.
PMCID: PMC1763946

Medical costs of smoking in the United States: estimates, their validity, and their implications


OBJECTIVE—To compare estimates of the medical costs of smoking in the United 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" and "cost", with review of article reference lists.
STUDY SELECTION—Peer-reviewed papers examining medical costs in a single year, covering the non-institutionalised American population.
DATA EXTRACTION—Methods underlying study estimates were identified, described, and compared with attributable expenditure methodology in the literature dealing with costs of illness. Differences in methods were associated with implied differences in findings.
DATA SYNTHESIS—With one exception, the studies find the annual medical costs of smoking to constitute approximately 6-8% of American personal health expenditures. 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 estimate derives from analysis of smoking-attributable differences in all medical costs. However, the finding from the most recent study, also considering all medical costs, fell in the 6-8% range.
CONCLUSIONS—The medical costs of smoking in the United States equal, and may well exceed, the commonly referenced figure of 6-8%. This literature has direct methodological relevance to developing countries interested in assessing 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.

Keywords: medical costs; smoking; United States

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Selected References

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  • Hodgson TA, Meiners MR. Cost-of-illness methodology: a guide to current practices and procedures. Milbank Mem Fund Q Health Soc. 1982 Summer;60(3):429–462. [PubMed]
  • Jacobson PD, Warner KE. Litigation and public health policy making: the case of tobacco control. J Health Polit Policy Law. 1999 Aug;24(4):769–804. [PubMed]
  • Miller LS, Zhang X, Novotny T, Rice DP, Max W. State estimates of Medicaid expenditures attributable to cigarette smoking, fiscal year 1993. Public Health Rep. 1998 Mar-Apr;113(2):140–151. [PMC free article] [PubMed]
  • Bloch M, Daynard R, Roemer R. A year of living dangerously: the tobacco control community meets the global settlement. Public Health Rep. 1998 Nov-Dec;113(6):488–497. [PMC free article] [PubMed]
  • Luce BR, Schweitzer SO. Smoking and alcohol abuse: a comparison of their economic consequences. N Engl J Med. 1978 Mar 9;298(10):569–571. [PubMed]
  • Manning WG, Keeler EB, Newhouse JP, Sloss EM, Wasserman J. The taxes of sin. Do smokers and drinkers pay their way? JAMA. 1989 Mar 17;261(11):1604–1609. [PubMed]
  • Leu RE, Schaub T. Does smoking increase medical care expenditure? Soc Sci Med. 1983;17(23):1907–1914. [PubMed]
  • Oster G, Colditz GA, Kelly NL. The economic costs of smoking and benefits of quitting for individual smokers. Prev Med. 1984 Jul;13(4):377–389. [PubMed]
  • Hodgson TA. Cigarette smoking and lifetime medical expenditures. Milbank Q. 1992;70(1):81–125. [PubMed]
  • Kristein MM. Economic issues in prevention. Prev Med. 1977 Jun;6(2):252–264. [PubMed]
  • Hedrick JL. The economic costs of cigarette smoking. HSMHA Health Rep. 1971 Feb;86(2):179–182. [PMC free article] [PubMed]
  • Boden LI. The economic impact of environmental disease on health care delivery. J Occup Med. 1976 Jul;18(7):467–476. [PubMed]
  • Cooper BS, Rice DP. The economic cost of illness revisited. Soc Secur Bull. 1976 Feb;39(2):21–36. [PubMed]
  • Hodgson TA, Kopstein AN. Health care expenditures for major diseases in 1980. Health Care Financ Rev. 1984 Summer;5(4):1–12. [PubMed]
  • Rice DP, Hodgson TA, Sinsheimer P, Browner W, Kopstein AN. The economic costs of the health effects of smoking, 1984. Milbank Q. 1986;64(4):489–547. [PubMed]
  • Miller LS, Zhang X, Rice DP, Max W. State estimates of total medical expenditures attributable to cigarette smoking, 1993. Public Health Rep. 1998 Sep-Oct;113(5):447–458. [PMC free article] [PubMed]
  • Miller VP, Ernst C, Collin F. Smoking-attributable medical care costs in the USA. Soc Sci Med. 1999 Feb;48(3):375–391. [PubMed]
  • Ray NF, Thamer M, Taylor T, Fehrenbach SN, Ratner R. Hospitalization and expenditures for the treatment of general medical conditions among the U.S. diabetic population in 1991. J Clin Endocrinol Metab. 1996 Oct;81(10):3671–3679. [PubMed]
  • Economic consequences of diabetes mellitus in the U.S. in 1997. American Diabetes Association. Diabetes Care. 1998 Feb;21(2):296–309. [PubMed]
  • Glantz SA, Parmley WW. Passive smoking and heart disease. Mechanisms and risk. JAMA. 1995 Apr 5;273(13):1047–1053. [PubMed]
  • Kaiserman MJ. The cost of smoking in Canada, 1991. Chronic Dis Can. 1997;18(1):13–19. [PubMed]
  • Single E, Robson L, Xie X, Rehm J. The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992. Addiction. 1998 Jul;93(7):991–1006. [PubMed]
  • Forbes WF, Thompson ME. Estimating the health care costs of smokers. Can J Public Health. 1983 May-Jun;74(3):183–190. [PubMed]
  • Jin SG, Lu BY, Yan DY, Fu ZY, Jiang Y, Li W. An evaluation on smoking-induced health costs in China (1988-1989). Biomed Environ Sci. 1995 Dec;8(4):342–349. [PubMed]
  • Chen J, Cao JW, Chen Y, Shao DY. Evaluation of medical cost lost due to smoking in Chinese cities. Biomed Environ Sci. 1995 Dec;8(4):335–341. [PubMed]
  • Liu BQ, Peto R, Chen ZM, Boreham J, Wu YP, Li JY, Campbell TC, Chen JS. Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths. BMJ. 1998 Nov 21;317(7170):1411–1422. [PMC free article] [PubMed]
  • Barendregt JJ, Bonneux L, van der Maas PJ. The health care costs of smoking. N Engl J Med. 1997 Oct 9;337(15):1052–1057. [PubMed]
  • Hodgson TA. The health care costs of smoking. N Engl J Med. 1998 Feb 12;338(7):470–472. [PubMed]

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