No abstract

Potential reductions in the costs related to asthma in the United States may be identified through a closer examination of the effectiveness of care associated with each category of cost. Future health policy efforts to improve the effectiveness of primary care interventions for asthma in the ambulatory setting may reduce the costs of this common illness.

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. DiVerences 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 diVerences 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-ofsmoking burden and their future burdens, with diVerences in tobacco use histories and the availability of chronic disease treatment aVecting countryspecific 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 tobaccoproduced disease. (Tobacco Control 1999;8:290-300)

The economic burden of hypertension is large, but health services directly related to hypertension account for only a fraction of attributed expenditures. Comprehensive accounting of expenditures more accurately assesses the cost of hypertension and potential savings from prevention and treatment. Alteration of lifestyles and medical intervention provide opportunities to reduce national health expenditures.