Predictive validation and forecasts of short-term changes in healthcare expenditure associated with changes in smoking behavior in the United States

Abstract

ObjectivesOut-of-sample forecasts are used to evaluate the predictive adequacy of a previously published national model of the relationship between smoking behavior and real per capita health care expenditure using state level aggregate data. In the previously published analysis, the elasticities between changes in state adult current smoking prevalence and mean cigarette consumption per adult current smoker and healthcare expenditures were 0.118 and 0.108 This new analysis provides evidence that the model forecasts out-of-sample well. MethodsOut-of-sample predictive performance was used to find the best specification of trend variables and the best model to bridge a break in survey data used in the analysis. Monte-Carlo simulation was used to calculate forecast intervals for the effect of changes in smoking behavior on expected real per capita healthcare expenditures. OPEN ACCESSCitation: Lightwood J, Anderson S, Glantz SA (2020) Predictive validation and forecasts of shortterm changes in healthcare expenditure associated with changes in smoking behavior in the United States. PLoS ONE 15(1): e0227493. https://doi. SAG and as a consulting agreement with SA. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The decreases of 5% each year. Given the limitations of time series modelling in a relatively short time series, the effect of changes in smoking behavior may occur over several years, even though the model contains only one lag for the explanatory variables. ConclusionReductions in smoking produce substantial savings in real per capita healthcare expenditure in short to medium term. A 5% relative drop in smoking prevalence (about a 0.87% reduction in absolute prevalence) combined with a 5% drop in consumption per remaining smoker (about 16 packs/year) would be followed by a $31.5 billion reduction in healthcare expenditure (in 2014 dollars).

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“…This level change also affected the consumption series, which is a function of prevalence. The break was modeled using the same techniques used for previously published national panel data estimates [10,11] of the effect of state level smoking behavior on healthcare expenditure. Following the previous research [12,13], a measurement adjustment model was added to the regression to model…”

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