The association of smoking status with healthcare utilisation, productivity loss and resulting costs: results from the population-based KORA F4 study

Abstract

BackgroundSmoking is seen as the most important single risk to health today, and is responsible for a high financial burden on healthcare systems and society. This population-based cross-sectional study compares healthcare utilisation, direct medical costs, and costs of productivity losses for different smoking groups: current smokers, former smokers, and never smokers.MethodsUsing a bottom-up approach, data were taken from the German KORA F4 study (2006/2008) on self-reported healthcare utilisation and work absence due to illness for 3,071 adults aged 32-81 years. Unit costs from a societal perspective were applied to utilisation. Utilisation and resulting costs were compared across different smoking groups using generalised linear models to adjust for age, sex, education, alcohol consumption and physical activity.ResultsAverage annual total costs per survey participant were estimated as €3,844 [95% confidence interval: 3,447-4,233], and differed considerably between smoking groups with never smokers showing €3,237 [2,802-3,735] and former smokers causing €4,398 [3,796-5,058]. There was a positive effect of current and former smoking on the utilisation of healthcare services and on direct and indirect costs. Total annual costs were more than 20% higher (p<0.05) for current smokers and 35% higher (p<0.01) for former smokers compared with never smokers, which corresponds to annual excess costs of €743 and €1,108 per current and former smoker, respectively.ConclusionsResults indicate that excess costs for current and former smokers impose a large burden on society, and that previous top-down cost approaches produced lower estimates for the costs of care for smoking-related diseases. Efforts must be focused on prevention of smoking to achieve sustainable containment on behalf of the public interest.

The association between smoking status and hospital length of stay: evidence from a hospital-based cohort

“…[4,[12][13][14][15] Another study in a developed country also found that current smokers were more likely to be hospitalized compared to nonsmokers. In addition, current smokers were more likely to have frequent outpatient visits compared to nonsmokers.…”

“…[1,2] It accounts for more than 5 million deaths annually and imposes both health and financial burdens on individuals, health systems, and society as a whole. [3,4] In Iran, the prevalence of smoking is about 12.5% (of which 23.4% males and 1.4% females) and on average an individual used to smoke 13.7 cigarettes daily. [5] A study in Iran in 2012 indicated that smoking is accountable for 4623 cancer deaths, 80,808 years of potential life lost, and $US 83,019,583 cost of productivity losses.…”

“…[3] Previous studies also reported the influence of smoking on medical services utilization, absenteeism from work, and health-care costs among current and former smokers compared with nonsmokers. [4,[6][7][8] Hospital length of stay (LOS) of patients is one of the main indicators that can be influenced by smoking status. [1] Identifying factors affecting LOS is the first step toward decreasing LOS and improving quality of inpatient services.…”

Estimates of costs for modelling return on investment from smoking cessation interventions

“…In England, Germany, Hungary and Spain data on the number of days lost per smoker came from the published sources 56, 57, 58, 59, whereas in the Netherlands, reports on health‐care figures were available to derive the number of lost work‐days 60. Average hourly wage was obtained in all cases through search and analysis of national databases 61, 62, 63, 64.…”

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

“…In contrast to males, the mortality rate of lung cancer in females has been rising in Germany for more than three decades, with smoking as the biggest risk factor 6, 7. Using survey data, health‐related costs of smoking in Germany have been estimated to amount to more than €30 billion per year 8. Thus, tobacco control remains a fundamental leverage point to improve population health outcomes 9.…”