Smoking-related costs among 25 to 59 year-old males in a 19-year individual follow-up

Objective: To estimate the health care expenditure and productivity losses due to smoking. Design: A retrospective cohort study of a random population sample of 5,247 men aged 25-59 years from the provinces of Kuopio and North Karelia in eastern Finland. Subjects initially surveyed in 1972 were linked to a set of national registers through their social security identification numbers and followed for 19 years. The difference in the number of life years and work years lost, the costs of drugs and hospitalization, and the value of productivity lost due to disability and premature mortality between smokers, former smokers and never-smokers was analysed. Results: The difference in mean life expectancy between current smokers and never-smokers was 3.0 years, and the difference in mean lost work time was 2.6 years over the 19 years of follow-up. Between current smokers and former smokers, the difference in mean life expectancy was 1.8 years, and the difference in mean lost work time was 1.6 years. The mean difference between a current smoker and a never-smoker in health service costs was Euro 2,900, and the difference in mean total costs was Euro 69,300 (an increase of 86%). No difference in mean health care costs between current smokers and former-smokers was found, while the difference in mean total cost was Euro 44,000. Conclusions: Smokers incurred excess costs in terms of both direct health care expenditure and indirect productivity losses in comparison to the never-smoking population. Most importantly, quitting smoking could save at least 60% of the losses related to excess mortality and disability of smokers.