Purpose: To summarize our knowledge of the economic impact of smoking on health-related outcomes and to discuss the quality of this evidence. The potential effect of smoking-related health promotion programs on reducing costs is discussed.
Data sources: Studies reviewed were cited in recently published reviews, identified through database searches of MEDLINE/HealthSTAR, PsychINFO, and ABI/Inform or obtained from reference lists of other studies.
Study inclusion and exclusion criteria: Included are studies of the health care and other costs of smoking published in English in peer-reviewed journals during the last 20 years. Studies of annual and lifetime costs are included as are studies of employer costs. Forty-nine studies were reviewed.
Data extraction methods: Data extracted were total costs, medical care and other direct costs, lost productivity, and mortality costs. Underlying methodologies were described and compared.
Data synthesis: The annual cost of smoking is between 6 and 14% of personal health expenditures. Estimates have increased over time, reflecting better and more comprehensive methodologies. Smoking appears to result in increased lifetime costs, although some studies havefound contrary results. In the workplace, smokers incur greater medical costs and more lost productivity than nonsmokers. They also impose costs on their nonsmoking co-workers.
Major conclusions: The overwhelming body of evidence in the literature asserts that smoking imposes costs on an annual basis, that it leads to increased medical costs over the life span, and that many of these costs are borne by employers. Although the methods for studying this issue have evolved over time and are presently quite comprehensive, future research is needed to further substantiate the findings and develop further refinements.