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Estimating the costs of tobacco use
Abstract
There is no doubt that smoking is damaging global health on an unprecedented scale. However, there is continuing debate on the economics of tobacco control, including the costs and consequences of tobacco control policies. This book aims to fill the analytic gap around this debate This book brings together a set of critical reviews of the current status of knowledge on tobacco control. While the focus is on the needs of low-income and middle- income countries, the analyses are relevant globally. The book examines tobacco use and its consequences including new analyses of welfare issues in tobacco consumption, poverty and tobacco, and the rationale for government involvement. It provides an evidence-based review of policies to reduce demand including taxation, information, and regulation. It critically reviews supply-side issues such as trade and industry and farming issues, including new analyses on smuggling. It also discusses the impact of tobacco control programs on economies, including issues such as employment, tax revenue and welfare losses. It provides new evidence on the effectiveness and cost-effectiveness of control interventions. Finally, it outlines broad areas for national and international action, including future research directions. A statistical annex will contain information on where the reader can find data on tobacco consumption, prices, trade, employment and other items. The book is directed at academic economists and epidemiologists as well as technical staff within governments and international agencies. Students of economics, epidemiology and public policy will find this an excellent comprehensive introduction to economics of tobacco control.
... 22 22 This approach does not attempt to account for the value of the lives lost to tobacco-related diseases. Exercises to impute an economic value to those lives face a variety of methodological caveats in the literature (see Lightwood et al. 2000 for a discus-37 the price of the tobacco product. The model evaluates the first-order effects of a change in prices, relying on the empirical estimation of price elasticities of demand (at the level of income-deciles) to simulate consumer behavioral responses. ...
... ECBA on the distributional impact of tobacco taxation policies originates in the literature that has long sought to understand and quantify the social and economic costs of smoking. An extensive array of methodologies to estimate these costs has nonetheless faced important conceptual and empirical challenges (seeLightwood et al. 2000 for a detailed discussion). More recently, Verguet et al. (2015) and Pichon et al. (2014) developed ECBA methodologies to quantify the distributional effects of increasing taxes on tobacco. ...
... This approach does not attempt to account for the value of the lives lost to tobacco-related diseases. Exercises to impute an economic value to those lives face a variety of methodological caveats in the literature (seeLightwood et al. 2000 for a discussion). The proposed ECBA takes the more modest years of life lost approach to capture the labor income flows that households lose due to tobacco illnesses. ...
... La recaudación en concepto de impuestos sobre el consumo de tabaco cubre menos de un tercio de estos costos y apenas llega a los USD 145 mil millones (2). Tan solo los costos médicos directos producidos por el consumo del tabaco pueden llegar a representar pérdidas para los países de hasta 1% de su producto bruto interno (PIB) y ser responsables de 15% de todos los gastos sanitarios (6). ...
... A nivel global, existe abundante bibliografía que muestra que los costos médicos atribuibles al tabaquismo pueden impactar de modo importante en las economías de los países, afectando entre 0,1% y 1,1% de todo el PIB (6). Nuestros hallazgos muestran que esta situación se repite en América Latina donde, en promedio, 0,7% del PIB se pierde en la atención de los problemas de salud producidos por el tabaco (entre 0,4% en México y 0,9% en Chile). ...
... Es importante remarcar que este estudio estimó únicamente los costos médicos directos producidos por el tabaco, los cuales son solo una parte menor del total de la carga económica que el tabaco impone a los países. Si a los costos médicos directos se suman los costos por productividad perdida y otros costos sociales, la carga económica del tabaquismo puede duplicarse o triplicarse (2,5,6,26). Un estudio previo realizado en Argentina mostró que tan solo las pérdidas de ingresos futuros por mortalidad prematura atribuible al tabaquismo representaban 0,17% del PIB cada año (27). ...
Background
Tobacco use is the leading cause of preventable
deaths worldwide. The objective of this study was to estimate the burden of
disease attributable to tobacco use and to evaluate the potential impact of increasing
cigarette´s price through taxes in Argentina, Bolivia, Brazil, Chile, Colombia,
Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru and Uruguay-countries which
encompass 84% of Latin America´s population.
Methods
A microsimulation model was used
to estimate the chances people have to get sick or die from 17 smoking-related
conditions. An extensive review was conducted to identify key epidemiological
and cost data relevant to each country.
Results
Every year, smoking is
responsible for 293,364 deaths, 862,484 COPD cases (Chronic Obstructive
Pulmonary Disease), 832,791 cardiovascular events, 131,037 cancer diagnoses and
28,098 USD millions in direct medical costs to the health systems in these
countries. The proportion of health expenditure that these burden represent
range from 3.2% in Honduras to 16,6% in Uruguay; and the proportion of the total
GDP (Gross Domestic Product) ranged from 0.3% to 1.5% respectively. The percentage
of attributable health expenditures recovered through tobacco taxes also varies
widely: Mexico, Honduras, Argentina and Chile recover over 45%; in Ecuador tax revenues
reach 40%; Brazil, Costa Rica, Paraguay and Uruguay recover less than 30%, and Bolivia,
Colombia and Peru, less than 10%.
Different
scenarios of cigarette price increases through taxes were modeled for each
country. An example -the case for Brazil- is shown in the table below.
Cigarette price increase through taxes 25% 50% 100% Avoided deaths 68,241 136,482 272,964 Avoided events 336,099 672,199 1,344,398 Direct costs avoided (USD millions) 4,866 9,732 19,464 Indirect costs avoided (USD millions) 2,995 8,980 8,411
[Potential benefts on different scenarios, Brazil]
Conclusions
The burden of disease
and related direct health expenditure in Latin America is very high and tax
revenues from the sale of tobacco products are far below the levels needed to
cover it. Increasing cigarette´s price through taxes is an effective
intervention to reduce tobacco-attributable burden of disease and health
expenditures in Latin America.
... La recaudación en concepto de impuestos sobre el consumo de tabaco cubre menos de un tercio de estos costos y apenas llega a los USD 145 mil millones (2). Tan solo los costos médicos directos producidos por el consumo del tabaco pueden llegar a representar pérdidas para los países de hasta 1% de su producto bruto interno (PIB) y ser responsables de 15% de todos los gastos sanitarios (6). ...
... A nivel global, existe abundante bibliografía que muestra que los costos médicos atribuibles al tabaquismo pueden impactar de modo importante en las economías de los países, afectando entre 0,1% y 1,1% de todo el PIB (6). Nuestros hallazgos muestran que esta situación se repite en América Latina donde, en promedio, 0,7% del PIB se pierde en la atención de los problemas de salud producidos por el tabaco (entre 0,4% en México y 0,9% en Chile). ...
... Es importante remarcar que este estudio estimó únicamente los costos médicos directos producidos por el tabaco, los cuales son solo una parte menor del total de la carga económica que el tabaco impone a los países. Si a los costos médicos directos se suman los costos por productividad perdida y otros costos sociales, la carga económica del tabaquismo puede duplicarse o triplicarse (2,5,6,26). Un estudio previo realizado en Argentina mostró que tan solo las pérdidas de ingresos futuros por mortalidad prematura atribuible al tabaquismo representaban 0,17% del PIB cada año (27). ...
Objective:
Estimate smoking-attributable direct medical costs in Latin American health systems.
Methods:
A microsimulation model was used to quantify financial impact of cardiovascular and cerebrovascular disease, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and nine other neoplasms. A systematic search for epidemiological data and event costs was carried out. The model was calibrated and validated for Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, countries that account for 78% of Latin America's population; the results were then extrapolated to the regional level.
Results:
Every year, smoking is responsible for 33 576 billion dollars in direct costs to health systems. This amounts to 0.7% of the region's gross domestic product (GDP) and 8.3% of its health budget. Cardiovascular disease, COPD, and cancer were responsible for 30.3%, 26.9%, and 23.7% of these expenditures, respectively. Smoking-attributable costs ranged from 0.4% (Mexico and Peru) to 0.9% (Chile) of GDP and from 5.2% (Brazil) to 12.7% (Bolivia) of health expenditures. In the region, tax revenues from cigarette sales barely cover 37% of smoking-attributable health expenditures (8.1% in Bolivia and 67.3% in Argentina).
Conclusions:
Smoking is responsible for a significant proportion of health spending in Latin America, and tax revenues from cigarette sales are far from covering it. The region's countries should seriously consider stronger measures, such as an increase in tobacco taxes.
... La recaudación en concepto de impuestos sobre el consumo de tabaco cubre menos de un tercio de estos costos y apenas llega a los USD 145 mil millones (2). Tan solo los costos médicos directos producidos por el consumo del tabaco pueden llegar a representar pérdidas para los países de hasta 1% de su producto bruto interno (PIB) y ser responsables de 15% de todos los gastos sanitarios (6). ...
... A nivel global, existe abundante bibliografía que muestra que los costos médicos atribuibles al tabaquismo pueden impactar de modo importante en las economías de los países, afectando entre 0,1% y 1,1% de todo el PIB (6). Nuestros hallazgos muestran que esta situación se repite en América Latina donde, en promedio, 0,7% del PIB se pierde en la atención de los problemas de salud producidos por el tabaco (entre 0,4% en México y 0,9% en Chile). ...
... Es importante remarcar que este estudio estimó únicamente los costos médicos directos producidos por el tabaco, los cuales son solo una parte menor del total de la carga económica que el tabaco impone a los países. Si a los costos médicos directos se suman los costos por productividad perdida y otros costos sociales, la carga económica del tabaquismo puede duplicarse o triplicarse (2,5,6,26). Un estudio previo realizado en Argentina mostró que tan solo las pérdidas de ingresos futuros por mortalidad prematura atribuible al tabaquismo representaban 0,17% del PIB cada año (27). ...
Objetivo
Estimar los costos médicos directos atribuibles al tabaquismo en los sistemas de salud de América Latina.
Métodos
Se utilizó un modelo de microsimulación para cuantificar el impacto económico en enfermedad cardiovascular y cerebrovascular, enfermedad pulmonar obstructiva crónica (EPOC), neumonía, cáncer de pulmón y otras nueve neoplasias. Se realizó una búsqueda sistemática de datos epidemiológicos y de costos de los eventos. El modelo se calibró y validó para Argentina, Bolivia, Brasil, Chile, Colombia, México y Perú, países que representan el 78% de la población de América Latina; luego se extrapolaron los resultados a nivel regional.
Resultados
Cada año el tabaquismo es responsable de 33 576 millones de dólares en costos directos para el sistema de salud. Esto equivale a 0,7% del producto interno bruto (PIB) de la región y a 8,3% del presupuesto sanitario. La enfermedad cardiovascular, la EPOC y el cáncer fueron responsables de 30,3%, 26,9% y 23,7% de este gasto, respectivamente. El costo atribuible al tabaquismo varió entre 0,4% (México y Perú) y 0,9% (Chile) del PIB y entre 5,2% (Brasil) y 12,7% (Bolivia) del gasto en salud. En la región, la recaudación impositiva por la venta de cigarrillos apenas cubre 37% del gasto sanitario atribuible al tabaquismo (8,1% en Bolivia y 67,3% en Argentina).
Conclusiones
El tabaquismo es responsable de una importante proporción del gasto sanitario en América Latina, y la recaudación impositiva por la venta de cigarrillos está lejos de llegar a cubrirlo. La profundización de medidas como el aumento de impuestos al tabaco debería ser seriamente considerada por los países de la región.
... A nivel global, el tabaquismo es una de las principales causas de enfermedad y muerte evitable, se le atribuye el 6,3% de las muertes prematuras y años de vida ajustados a discapacidad ocurridos en el mundo entre 1990 y 2010 (1) . En Sudamérica ocupa el tercer lugar dentro de los factores de riesgo de muertes y años de vida saludables perdidos (1) , generando baja productividad y aumento del gasto de bolsillo que afecta la economía de los individuos (2) , así como de altos costos para los sistemas de salud (3) . En Perú, la prevalencia del tabaquismo fluctúa entre 19 y 36% en hombres y entre 10 a 18% en mujeres (4) ; sin embargo, algunos estudios en áreas periurbanas de Lima muestran menores prevalencias (5) . ...
... El aumento del precio de cigarrillos a través de impuestos ha demostrado ser una medida muy costo-efectiva para el control del tabaquismo (3,7) . Con ello, se alentaría al consumidor a dejar de fumar, aumentando el número y éxito de los intentos (8) , previniendo el inicio en jóvenes, desalentando a exfumadores a reincidir y disminuyendo el consumo entre los fumadores (9,10) con la consecuente reducción de carga de enfermedad y costos sanitarios. ...
... Una estrategia razonable y utilizada en otros países, seria un incremento en 50% del precio de cigarrillos a través de los impuestos, esto podría no solamente prevenir las muertes y eventos, sino, además, lograr un beneficio económico de más de PEN 3,1 mil millones en diez años. Dicho incremento sería consistente con numerosos estudios que reportan resultados similares en términos de carga global y en la reducción potencial del consumo a través de los impuestos (3,7,44) , así como también, estaría aún por debajo del 65% del precio de venta recomendado por el Banco Mundial; de los dos tercios o cuatro quintos que se impone en países de altos ingresos y con precios por cajetilla equiparados con países de la región (11,45) . ...
Objetivos
. Estimar la carga de enfermedad asociada al tabaquismo y evaluar el potencial impacto económico y en salud del aumento de los impuestos a los cigarrillos en el Perú.
Materiales y métodos.
Mediante un modelo de microsimulación se estimó el impacto en mortalidad, calidad de vida y costos atribuibles al tabaquismo por enfermedad cardiaca y cerebrovascular, enfermedad pulmonar obstructiva crónica, neumonía, cáncer de pulmón y otras nueve neoplasias. Se evaluaron tres escenarios de aumento de impuestos.
Resultados
. Un total anual de 16 719 muertes, 6926 diagnósticos de cáncer, 7936 accidentes cerebrovasculares y 7548 hospitalizaciones por enfermedad cardiovascular se pueden atribuir al tabaquismo en Perú. Asimismo, se pierden 396 069 años de vida por muerte prematura y discapacidad cada año, y el costo de tratar los problemas de salud ocasionados por el tabaco asciende a 2500 millones de soles (PEN 2015). Actualmente, los impuestos al tabaco llegan a cubrir solamente el 9,1% de dicho gasto. Un incremento del 50% en el precio de los cigarrillos podría evitar 13 391 muertes, 6210 eventos cardiovasculares y 5361 nuevos cánceres en los próximos diez años, y representaría un beneficio económico de 3145 millones (PEN) por ahorro de costos sanitarios y aumento de la recaudación impositiva.
Conclusiones
. La carga de enfermedad y el costo para el sistema de salud asociados al tabaquismo son elevados en Perú. Incrementar los impuestos al cigarrillo podría derivar en importantes beneficios para el país, tanto sanitarios como económicos.
... La recaudación en concepto de impuestos sobre el consumo de tabaco cubre menos de un tercio de estos costos y apenas llega a los USD 145 mil millones (2). Tan solo los costos médicos directos producidos por el consumo del tabaco pueden llegar a representar pérdidas para los países de hasta 1% de su producto bruto interno (PIB) y ser responsables de 15% de todos los gastos sanitarios (6). ...
... A nivel global, existe abundante bibliografía que muestra que los costos médicos atribuibles al tabaquismo pueden impactar de modo importante en las economías de los países, afectando entre 0,1% y 1,1% de todo el PIB (6). Nuestros hallazgos muestran que esta situación se repite en América Latina donde, en promedio, 0,7% del PIB se pierde en la atención de los problemas de salud producidos por el tabaco (entre 0,4% en México y 0,9% en Chile). ...
... Es importante remarcar que este estudio estimó únicamente los costos médicos directos producidos por el tabaco, los cuales son solo una parte menor del total de la carga económica que el tabaco impone a los países. Si a los costos médicos directos se suman los costos por productividad perdida y otros costos sociales, la carga económica del tabaquismo puede duplicarse o triplicarse (2,5,6,26). Un estudio previo realizado en Argentina mostró que tan solo las pérdidas de ingresos futuros por mortalidad prematura atribuible al tabaquismo representaban 0,17% del PIB cada año (27). ...
Objetivo. Estimar los costos médicos directos atribuibles al tabaquismo en los sistemas de salud de América Latina.
Métodos. Se utilizó un modelo de microsimulación para cuanti car el impacto económico en enfermedad cardiovascular y cerebrovascular, enfermedad pulmonar obstructiva crónica (EPOC), neumonía, cáncer de pulmón y otras nueve neoplasias. Se realizó una búsqueda siste- mática de datos epidemiológicos y de costos de los eventos. El modelo se calibró y validó para Argentina, Bolivia, Brasil, Chile, Colombia, México y Perú, países que representan el 78% de la población de América Latina; luego se extrapolaron los resultados a nivel regional. Resultados. Cada año el tabaquismo es responsable de 33 576 millones de dólares en costos direc- tos para el sistema de salud. Esto equivale a 0,7% del producto interno bruto (PIB) de la región y a 8,3% del presupuesto sanitario. La enfermedad cardiovascular, la EPOC y el cáncer fueron respon- sables de 30,3%, 26,9% y 23,7% de este gasto, respectivamente. El costo atribuible al tabaquismo varió entre 0,4% (México y Perú) y 0,9% (Chile) del PIB y entre 5,2% (Brasil) y 12,7% (Bolivia) del gasto en salud. En la región, la recaudación impositiva por la venta de cigarrillos apenas cubre 37% del gasto sanitario atribuible al tabaquismo (8,1% en Bolivia y 67,3% en Argentina). Conclusiones. El tabaquismo es responsable de una importante proporción del gasto sanita- rio en América Latina, y la recaudación impositiva por la venta de cigarrillos está lejos de llegar a cubrirlo. La profundización de medidas como el aumento de impuestos al tabaco debería ser seriamente considerada por los países de la región.
... La recaudación en concepto de impuestos sobre el consumo de tabaco cubre menos de un tercio de estos costos y apenas llega a los USD 145 mil millones (2). Tan solo los costos médicos directos producidos por el consumo del tabaco pueden llegar a representar pérdidas para los países de hasta 1% de su producto bruto interno (PIB) y ser responsables de 15% de todos los gastos sanitarios (6). ...
... A nivel global, existe abundante bibliografía que muestra que los costos médicos atribuibles al tabaquismo pueden impactar de modo importante en las economías de los países, afectando entre 0,1% y 1,1% de todo el PIB (6). Nuestros hallazgos muestran que esta situación se repite en América Latina donde, en promedio, 0,7% del PIB se pierde en la atención de los problemas de salud producidos por el tabaco (entre 0,4% en México y 0,9% en Chile). ...
... Es importante remarcar que este estudio estimó únicamente los costos médicos directos producidos por el tabaco, los cuales son solo una parte menor del total de la carga económica que el tabaco impone a los países. Si a los costos médicos directos se suman los costos por productividad perdida y otros costos sociales, la carga económica del tabaquismo puede duplicarse o triplicarse (2,5,6,26). Un estudio previo realizado en Argentina mostró que tan solo las pérdidas de ingresos futuros por mortalidad prematura atribuible al tabaquismo representaban 0,17% del PIB cada año (27). ...
... Em 1989, a Pesquisa Nacional em Saúde e Nutrição (PNSN) revelou prevalência de tabagismo de 34,8% entre adultos de 18 anos ou mais 9 . O Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) revelou que, entre 2006 e 2011, a prevalência do tabagismo reduziu de 16,2% (intervalo de 95% de confiança -IC95%: 15,[4][5][6][7][8][9][10][11][12][13][14][15][16]9) para 14,8% (IC95%: 13,[9][10][11][12][13][14][15]7), na mesma faixa etária 5 . A prevalência estimada em 2012 foi de 12,1% (IC95%: 11,[5][6][7][8][9][10][11][12]8) 10 . ...
... Em 1989, a Pesquisa Nacional em Saúde e Nutrição (PNSN) revelou prevalência de tabagismo de 34,8% entre adultos de 18 anos ou mais 9 . O Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) revelou que, entre 2006 e 2011, a prevalência do tabagismo reduziu de 16,2% (intervalo de 95% de confiança -IC95%: 15,[4][5][6][7][8][9][10][11][12][13][14][15][16]9) para 14,8% (IC95%: 13,[9][10][11][12][13][14][15]7), na mesma faixa etária 5 . A prevalência estimada em 2012 foi de 12,1% (IC95%: 11,[5][6][7][8][9][10][11][12]8) 10 . ...
... O Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) revelou que, entre 2006 e 2011, a prevalência do tabagismo reduziu de 16,2% (intervalo de 95% de confiança -IC95%: 15,[4][5][6][7][8][9][10][11][12][13][14][15][16]9) para 14,8% (IC95%: 13,[9][10][11][12][13][14][15]7), na mesma faixa etária 5 . A prevalência estimada em 2012 foi de 12,1% (IC95%: 11,[5][6][7][8][9][10][11][12]8) 10 . ...
O estudo teve como objetivo descrever a evolução dos gastos com cigarro das famílias brasileiras e seu peso sobre a renda dessas no período de 2002-2009. Foram utilizados dados da Pesquisa de Orçamentos Familiares (POF) de 2002/2003 e 2008/2009. Foi realizada correção dos valores mediante o Índice de Preços ao Consumidor Amplo (IPCA). A proporção de famílias que tiveram gastos com cigarro reduziu de 23,5% para 18,2%, no período estudado, mas o valor do gasto aumentou de R 59,45. O gasto foi maior à medida que aumentavam a renda e a escolaridade do chefe das famílias. As famílias com maior renda concentram a maior parte desses gastos, apesar da redução de sua contribuição no gasto total com cigarro. O comprometimento da renda na aquisição de cigarros foi de 5,2% no primeiro e de 1,2% no último quinto de renda. A política antitabagismo logrou êxitos na redução da prevalência do tabagismo no Brasil. Porém, medidas econômicas ainda são importantes no contexto nacional, tendo em vista que a parcela da renda e da despesa das famílias comprometida com cigarro apresentou redução.
... The appropriate level of this uniform tax per, say, pack of cigarettes, should depend, of course, on the total amount of the social costs of smoking divided by the number of packs consumed. On the basis of a careful review of a large number of studies, Lightwood et al. (2000) estimate that the gross costs of health care related to tobacco use -i.e. all costs in any given year that can be attributed to the extra health care needs of smokers -range from 0.1 to 1.1.% of GDP in high-income countries. ...
... From an economic point of view, therefore, it is net costs, which assess health care costs over a life-cycle, that should be the focus of analysis. Subject to a number of methodological caveats, Lightwood et al. (2000) conclude that the majority of the cross-section studies indicate that the net costs of smoking are positive. 10 These net costs are in the nature of a subsidy paid by nonsmokers to smokers who have higher lifetime health care costs than nonsmokers. ...
... Furthermore, gross costs in Finland for 1987 were estimated at 0.07-0.08% of GDP. For the references, see Lightwood et al. (2000). 10 An exception is a study for Finland (Pekurinen, 1992) which concludes that smoking involves net health care costs savings. ...
.........................................................................................................................................5
... Este fenómeno se observa en países en desarrollo, en los que el nivel de ingreso de la población ha aumentado más rápidamente que el precio de los cigarrillos, haciéndose estos más asequibles con el tiempo. El aumento de precios de los cigarrillos a través de los impuestos es una medida costo-efectiva y eficaz para controlar el tabaquismo, ya que desalienta el consumo de tabaco afectando principalmente el inicio en jóvenes, la probabilidad de re-incidencia de ex-fumadores y reduce el consumo entre los fumadores, disminuyendo de esta manera la carga de enfermedad y el coste sanitario (10)(11)(12)(13) . La política tributaria debe acompañarse de medidas adicionales para la reducción de la asequibilidad, como por ejemplo ajustes inflacionarios en forma automática. ...
... Este estudio corresponde a un grupo de trabajo en Latinoamérica que busca utilizar una modalidad de decisión con fuertes evidencias científicas e información convalidadas por expertos de varios países (14) ; sin embargo, presenta algunas limitaciones, puesto que es una estimación bastante conservadora debido principalmente a la falta de inclusión de una inmensa variedad de costos indirectos que podrían hasta triplicar los costos atribuibles al tabaquismo (10,34,35) . Por otra parte, cabe considerar la falta de datos precisos en Paraguay de ciertos parámetros epidemiológicos y de costos que son necesarios para el modelo, los cuales generan alguna incertidumbre en los resultados, pero que se intentan corregir con la calibración. ...
Objetivos. Estimar la carga de enfermedad asociada al consumo de tabaco en Paraguay y evaluar el potencial efecto económico y sanitario del aumento de precio mediante impuestos. Materiales y métodos. Se diseñó un modelo de microsimulación de Monte Carlo que incorporó la historia natural, costos y calidad de vida de enfermedades asociadas al tabaquismo para el 2015. Asimismo, se estimó el impacto en varios escenarios de aumento de impuestos sobre la prevalencia de tabaquismo y la recaudación fiscal. Resultados. 3354 personas mueren al año en Paraguay por consecuencia del tabaquismo. El 19 % de las muertes son por enfermedad isquémica cardíaca, el 15 % por accidentes cerebrovasculares. El 77 % de las muertes por enfermedad pulmonar obstructiva crónica y el 83 % de cáncer de pulmón son atribuibles al tabaquismo. Estas enfermedades en Paraguay representan un costo médico directo anual de más de 1,5 x 106 millones de guaraníes, mientras la recaudación impositiva por la venta de cigarrillos apenas llega a cubrir un 20 % de este gasto. Un aumento en el precio de los cigarrillos del 50 % vía impuestos, podría llevar a evitar 2507 muertes en diez años y generar recursos por 2,4 x 106 millones por ahorro en gastos sanitarios y aumento de recaudación. Conclusiones. El costo y la carga de enfermedad asociado al consumo de tabaco en el sistema de salud es elevado en Paraguay. Un aumento del precio de los cigarrillos a través de los impuestos tendría importantes beneficios sanitarios y podría compensar parcialmente los costos sanitarios.
... Both effects are incorporated in the disability-adjusted life years indicator. [45] Focusing on health care costs, Lightwood et al. (2000) estimate the cost of tobacco use. They suggest that the gross health care cost in high-income countries fluctuates between 0.1 percent and 1.0 percent of GDP. ...
... They suggest that the gross health care cost in high-income countries fluctuates between 0.1 percent and 1.0 percent of GDP. [46] In terms of price elasticities, limited data inhibit accurate estimates in low-and middle-countries, but the authors argue that the price elasticity could be as high as those in high-income countries. Meanwhile, Verguet et al. (2015) analyze the health effects of a price increase in China. ...
... Both effects are incorporated in the disability-adjusted life years indicator. [45] Focusing on health care costs, Lightwood et al. (2000) estimate the cost of tobacco use. They suggest that the gross health care cost in high-income countries fluctuates between 0.1 percent and 1.0 percent of GDP. ...
... They suggest that the gross health care cost in high-income countries fluctuates between 0.1 percent and 1.0 percent of GDP. [46] In terms of price elasticities, limited data inhibit accurate estimates in low-and middle-countries, but the authors argue that the price elasticity could be as high as those in high-income countries. Meanwhile [47] There would also be about 379,000 life days lost, which is more than a thousand years. ...
... Este fenómeno se observa en países en desarrollo, en los que el nivel de ingreso de la población ha aumentado más rápidamente que el precio de los cigarrillos, haciéndose estos más asequibles con el tiempo. El aumento de precios de los cigarrillos a través de los impuestos es una medida costo-efectiva y eficaz para controlar el tabaquismo, ya que desalienta el consumo de tabaco afectando principalmente el inicio en jóvenes, la probabilidad de re-incidencia de ex-fumadores y reduce el consumo entre los fumadores, disminuyendo de esta manera la carga de enfermedad y el coste sanitario (10)(11)(12)(13) . La política tributaria debe acompañarse de medidas adicionales para la reducción de la asequibilidad, como por ejemplo ajustes inflacionarios en forma automática. ...
... Este estudio corresponde a un grupo de trabajo en Latinoamérica que busca utilizar una modalidad de decisión con fuertes evidencias científicas e información convalidadas por expertos de varios países (14) ; sin embargo, presenta algunas limitaciones, puesto que es una estimación bastante conservadora debido principalmente a la falta de inclusión de una inmensa variedad de costos indirectos que podrían hasta triplicar los costos atribuibles al tabaquismo (10,34,35) . Por otra parte, cabe considerar la falta de datos precisos en Paraguay de ciertos parámetros epidemiológicos y de costos que son necesarios para el modelo, los cuales generan alguna incertidumbre en los resultados, pero que se intentan corregir con la calibración. ...
Objectives. To consider the burden of disease associated to tobacco consumption in Paraguay and to evaluate the potential economic and health effect of price increase through taxes. Materials and Methods. A Monte Carlo simulation model was designed incorporating natural history, costs, and quality of life of diseases associated to smoking for 2015. Also, several scenarios were considered for the impact of tax raises on the prevalence of smoking and fiscal collection. Results. In Paraguay, 3,354 people die every year as a consequence of smoking. Nineteen percent of deaths are due to cardiac ischemia, 15% due to stroke. 77% of deaths due to chronic obstructive pulmonary disease (COPD), and 83% of lung cancer can be attributed to smoking. These diseases in Paraguay represent an annual direct medical cost of more than 1.5 trillion PYG, while the tax collection from cigarette sales barely covers 20% of this expense. A 50% increase in
the price of cigarettes via taxes could avoid 2507 deaths in ten years and generate resources by 2.4 trillion in savings in health expenses and tax of collection. Conclusions. The cost and the burden of disease associated to tobacco consumption is high in the health system in Paraguay. An increase in cigarette price through taxes could have significanthealth benefits and could offset health costs in part.
... The traditional economic approach assumes that people are rational agents who maximise their own individual welfare (Lightwood et al, 1999). If drinkers know all the information regarding health risks from alcohol consumption and they pay the full cost of health care, they will not over-consume amounts of alcohol because they will include these private costs in their decision on how much to consume. ...
... Third, there in an issue of computing gross versus net costs. The gross costs are defined as all costs of treating attributable diseases (Lightwood et al, 1999). The net costs are a comparison of the life costs of drinkers versus those of non-drinkers. ...
The purpose of this paper is to calculate the effects of increasing alcohol taxation in Thailand. Standard economic analysis is applied to data from a range of sources. Results suggest that alcohol taxes in Thailand have only a small impact on consumption. Thus an alcohol tax increase results in only a modest rise in deadweight loss and a small reduction in social costs. Increasing the tax rate on alcohol generates higher expenditure and government tax revenue. Overall taxes on alcoholic beverages result in net benefits to the Thai economy. © 2016 School of Taxation and Business Law (Atax), UNSW Business School, UNSW Australia. All rights reserved.
... In an extensive review by the World Bank (Lightwood et al. 2000), the gross health care costs of smoking for high-income countries ranged from 0.10 to 1.1 percent of the gross domestic product, and most of the net-versus-gross cost studies showed net costs for smoking. ...
... Several studies (Warner et al. 1999;Chaloupka and Warner 2000;Lightwood et al. 2000;Max 2001) have reviewed these economic issues and ongoing controversies that primarily involve the net-versus-gross cost of tobacco on society. This controversy, however, ignores the main burden-that of health-when it dwells on the "benefits" of smoking that result from premature death. ...
This study was to identify the stages of change in smoking cessation behavior and factors associated with the stages of smoking cessation behavior according to the trans-theoretical model.
... Since the externalities from tobacco consumption may well be almost constant across each unit consumed, the average tax rate should closely approximate the marginal tax rate. The major reference for external cost studies is Lightwood et al. (2000). On the basis of a careful review of a large number of studies, these authors conclude that estimates of gross external costs range from 0.1 to 1.1 per cent of GDP in high-income countries. ...
... social security expenditures over a lifetime, that should be the focus of analysis. 34 Although Lightwood et al. (2000) conclude that the majority of the cross-section studies reviewed by them indicate that the net costs of smoking are small but positive, there are notable exceptions in the literature. On the basis of data from the Netherlands, for instance, Barendregt et al. (1997) calculated the length of time it takes for the cost of savings from smoking to be balanced by the increased costs from the longer life expectancies of non-smokers. ...
... This study identified some of the environmental problems which stem from deforestation and these include soil erosion, environmental pollution and biodiversity loss. The same problems were identified by Lightwood et al (2000) who indicated that the environmental damage caused by smallholder tobacco production included soil degradation, deforestation, and water pollution. In Tanzania, tobacco is the most important driving force behind land use changes (Abdallah et al, 2007). ...
The aim of this thesis is to assess the efficacy of smallholder tobacco farming as a tool for socioeconomic transformation in rural Zimbabwe. The study was carried out in the Marondera District of Mashonaland East Province. This thesis was prompted by the need to establish the extent to which smallholder tobacco farming contributes to poverty reduction. The research was based on a comparative analysis of earlier resettlement areas that were set up between the 1980s and early 1990s, the recently established fast track resettlement areas that were established after 2000, and the communal areas. The novelty of this study partly lies in the analysis of the socio-economic contribution of tobacco farming using a dual theoretical framework combining the Sustainable Livelihood Framework and Entitlement Approach in a dynamic macroeconomic environment. The thesis assesses how the macroeconomic environment that has prevailed in Zimbabwe since 2000 has influenced production of tobacco as a livelihood option. Based on a mixed method research design encompassing observations, key informant interviews and focus group discussions, as well as a questionnaire survey, and qualitative and quantitative data were collected and analysed thematically in a manner that provides basis for co-validation. The quantitative data were analysed in SPSS V16.0 and MS Excel 2013 environments, where correlation and regression analyses were undertaken. Correlation analysis was used to determine the variables which were related to tobacco output in the three farming areas. The results from the study showed the different sources of tobacco funding and how the prevailing economic conditions affected investment into tobacco farming. Furthermore deforestation, erosion and pollution were identified as the major problems resulting from tobacco farming.
... 7 Nearly 40 percent of these costs are concentrated in developing countries, reflecting the substantial burden experienced by this group of countries. Earlier estimates of Lightwood et al. (2000) indicate that the gross health cost of tobacco in high-income countries is between 0.1 percent and 1.0 percent of GDP. Likewise, Pichón-Riviere et al. (2014) estimate the annual direct cost of tobacco-related disease in the Chilean health system at approximately 0.6 percent of GDP. ...
... 4 Nearly 40 percent of these costs are concentrated in developing countries, reflecting the substantial burden experienced by this group of countries. Earlier estimates of Lightwood et al. (2000) indicate that the gross health costs of tobacco in highincome countries are between 0.1 percent and 1.0 percent of GDP. Likewise, Pichón-Riviere et al. (2014) estimate the annual direct costs of tobacco-related disease in the Chilean health system at approximately 0.6 percent of GDP. ...
... The highest share, according to these authors, was in high-income countries (US$1.12 trillion in PPP dollars), where the tobacco epidemic is most advanced. 3 The earlier estimates of Lightwood et al. (2000) indicate that the gross health cost of tobacco in high-income countries is between 0.1 percent and 1.0 percent of GDP. However, nearly 40 percent of the health and productivity costs related to tobacco are already concentrated in developing countries (Goodchild, Nargis, and Tursan d'Espaignet 2018). ...
... 16 According to estimates from high-income countries, smoking cost ranges from 2.1% to 3.4% of the gross domestic product (GDP) in Australia, from 1.4% to 1.9% in Canada, and 1% in the USA. [17][18][19] A study of the economic cost of active smoking in 152 countries, of all income levels, in 2012, estimated the global average cost at 1.8% of global GDP and the average cost for high-income countries at 2.2%. 20 Although the global study includes the Gulf Cooperation Council (GCC) countries, it focuses mainly on grouping cost estimates by country income level and WHO region. ...
Background
The economic cost of smoking has been determined in many high-income countries as well as at a global level. This paper estimates the economic cost of smoking and secondhand smoke (SHS) exposure in the six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates), for which no detailed study exists.
Methods
We used data from the Global Burden of Diseases Study 2016 and the cost-of-illness approach to estimate direct costs (healthcare expenditures) and indirect costs (productivity losses due to morbidity and mortality). Indirect cost was estimated with and without the inclusion of musculoskeletal disorders, using the human capital approach.
Results
Total cost of smoking and SHS was estimated to be purchasing power parity (PPP) 41.3 billion (1.25% of the combined GDP).
Conclusion
The economic cost of smoking and SHS in the GCC states is relatively low compared with other high-income countries. Scaling-up implementation of evidence-based policies will prevent the evolution of a tobacco epidemic with its negative consequences for health and public finances.
... 35,36 A limitation of our study is that, although it offers a robust estimate of the health and financial burden of smoking using the best available information in each country and applying a uniform and replicable method, other social costs are also considered. 4,37,38 Results obtained using our model showed that in Brazil, when a conser vative estimate of the productivity losses caused by tobacco was included in the analysis, the estimate of the economic burden of smoking increased by 50%, from 39·4 billion to 59·1 billion Brazilian Reais per year. 39 Another important limitation is that our model did not include the effects of passive smoking, perinatal effects, or other effects (such as losses from fires), although we did include an estimation of the effect of these factors based on estimates from other studies. ...
Andrés Pichon-Riviere, Andrea Alcaraz, Alfredo Palacios, Belén Rodríguez, Luz Myriam Reynales-Shigematsu, Márcia Pinto,
Marianela Castillo-Riquelme, Esperanza Peña Torres, Diana Isabel Osorio, Leandro Huayanay, Cesar Loza Munarriz, Belén Sáenz de Miera-Juárez, Verónica Gallegos-Rivero, Catherine De La Puente, María del Pilar Navia-Bueno, Joaquín Caporale, Javier Roberti, Sacha Alexis Virgilio,Federico Augustovski, Ariel Bardach
... Weight management before, during and after pregnancy [32]. Not only does smoking have dire health consequences -smokers die on average at least 10 years earlier than non-smokers [33,34] -but it also causes high health costs and loss of productivity [35]. Reducing tobacco consumption is therefore likely not only going to improve the health but also the wealth of a nation [36]. ...
The Republic of Moldova faces several concurrent health challenges most notably an increase in chronic non-communicable diseases, spiralling health care costs and widening health inequalities. To accelerate progress in their resolution there is a need for new and innovative health promotion and behaviour change communication interventions. The Ministry of Health, Labour and Social Protection in collaboration with the newly created National Agency for Public Health held a conference on the occasion of the Moldovan National Day of Health Promotion on 14th March 2018 in which national and invited international experts exchanged their views on (1) best practice examples of behaviour change interventions, health promotion activities and lessons learned from the UK and elsewhere; and (2) possible ways forward for Moldova to implement cost-effective and evidence-based intersectoral health promotion programmes. The experts provided recommendations on implementing behaviour change interventions to reduce and prevent obesity; on the creation of a favourable tobacco control environment to reduce smoking prevalence; and on how physical activity programme design can benefit from health psychology research. All these strategies could foster health promotion activities and ultimately contribute to improving the health outcomes of the Moldovan population.
... De acuerdo con la misma Ley: "los ingresos adicionales recaudados por efecto del aumento de la tarifa del impuesto al consumo de cigarrillos serán destinados a financiar el aseguramiento en salud". Este tipo de medidas han demostrado ser una estrategia costo-efectiva para controlar su consumo (3,7), dado que, un precio más alto alienta a las personas a intentar dejar de fumar aumentando el número y el éxito de los intentos (8), desalienta a los exfumadores a reincidir, disminuye el consumo entre los que continúan fumando y previene el inicio, sobre todo en los más jóvenes (9-11). ...
Objetivo:
estimar la carga de enfermedad asociada al consumo de tabaco en Colombia y evaluar el potencial efecto sanitario y económico del aumento de precio en los cigarrillos mediante impuestos.
Materiales y métodos:
se diseñó un modelo de simulación de Monte Cario de primer orden que incorporó la historia natural, los costos y la calidad de vida de enfermedades relacionadas con el consumo de tabaco en adultos. Se estimó el impacto en la prevalencia de tabaquismo y en la recaudación de diferentes escenarios de aumento de precio a través de impuestos.
Resultados:
en Colombia cada año mueren 32.088 personas como consecuencia del consumo de cigarrillo y pueden atribuírsele los siguientes porcentajes: el 16% de las muertes cardiovasculares, el 13% de las producidas por accidentes cerebrovasculares, el 77% de las muertes ocasionadas por enfermedad pulmonar obstructiva crónica y el 80% de las muertes por cáncer de pulmón. Las enfermedades relacionadas con el cigarrillo representan un costo directo anual al sistema de salud de más de 4,5 billones de pesos, mientras la recaudación impositiva por la venta de cigarrillos apenas logra cubrir un 10% de este gasto. Un aumento en el precio de los cigarrillos del 50% podría evitar, en un horizonte de 10 años, más de 45.000 muertes y generar recursos por 8 billones por ahorro en gastos sanitarios y aumento de recaudación.
Conclusiones:
la carga de enfermedad y el costo para el sistema de salud asociados al consumo de tabaco son muy elevados en Colombia. Un aumento del precio de los cigarrillos a través de los impuestos tendría importantes beneficios tanto sanitarios como económicos.
... The loss of productivity, measured in terms of PALYs, among the working population has economic implications. Our study is the first to examine this cost in terms 24 A study in Thailand reported that the economic burden of smoking was 0.8% of country GDP, while the revenue from tobacco industry only contributed to 0.5% of the total GDP. 25 The results of our study are not directly comparable to those of other studies because of the differences in evaluation time horizons, which varied from 1 to 50 years in our study (depending on the age of the smokers), and which for other studies was limited to a single year. We had also adopted a simple 'top-down' approach to allocating total GDP to EFT worker. ...
Objectives
This study aimed to examine the impact of smoking on productivity in Australia, in terms of years of life lost, quality-adjusted life years (QALYs) lost and the novel measure of productivity-adjusted life years (PALYs) lost.
Methods
Life table modelling using contemporary Australian data simulated follow-up of current smokers aged 20–69 years until age 70 years. Excess mortality, health-related quality of life decrements and relative reduction in productivity attributable to smoking were sourced from published data. The gross domestic product (GDP) per equivalent full-time (EFT) worker in Australia in 2016 was used to estimate the cost of productivity loss attributable to smoking at a population level.
Results
At present, approximately 2.5 million Australians (17.4%) aged between 20 and 69 years are smokers. Assuming follow-up of this population until the age of 70 years, more than 3.1 million years of life would be lost to smoking, as well as 6.0 million QALYs and 2.5 million PALYs. This equates to 4.2% of years of life, 9.4% QALYs and 6.0% PALYs lost among Australian working-age smokers. At an individual level, this is equivalent to 1.2 years of life, 2.4 QALYs and 1.0 PALY lost per smoker. Assuming (conservatively) that each PALY in Australia is equivalent to A388 billion.
Conclusions
This study highlights the potential health and productivity gains that may be achieved from further tobacco control measures in Australia via application of PALYs, which are a novel, and readily estimable, measure of the impact of health and health risk factors on work productivity.
... 7 Nearly 40 percent of these costs are concentrated in developing countries, reflecting the substantial burden experienced by this group of countries. Earlier estimates of Lightwood et al. (2000) indicate that the gross health cost of tobacco in high-income countries is between 0. Similarly, exposure to secondhand smoke has a strong relationship with many respiratory diseases among children and adults (DHHS 2004(DHHS , 2014Mason, Wheeler, and Brown 2015;Öberg et al. 2011). According to the World Health Organization, secondhand smoke is responsible for over 890,000 premature deaths per year (WHO 2017). ...
... Our estimates fell into the range of 0.1%-1.1% of GPD for high-income countries. 40 Direct health care costs ($339 million) took the largest proportion of total economic costs (47.3%). The direct health care costs of tobaccorelated diseases estimated for 2011 in the public health care sector The numbers in the table are rounded and so may not sum to totals. ...
Background:
Reduction in smoking prevalence does not necessarily reduce the costs of smoking as evidence shows in developed countries. We provide up-to-date estimates for direct and indirect costs attributable to smoking in Hong Kong in 2011 and compare with our 1998 estimates.
Methods:
We took a societal perspective to include lives and life years lost, health care costs and time lost from work in the costing. We followed guidelines on estimating costs of active smoking for those aged 35 years or above (35+) and costs due to SHS exposure for 35+, infants aged 12 months and under and children aged 15 and below. All costs are in US166 million, an increase of about 4% over the estimate in 1998. Our conservative estimate of the annual tobacco-related disease cost in 2011 was 4.7 billion.
Conclusion:
Despite the reduction in smoking prevalence, smoking-attributable disease still imposes a substantial economic burden on Hong Kong society. These findings support more stringent and effective tobacco control legislation, polices and measures.
Implications:
Current evidence shows reduction in smoking prevalence does not necessarily reduce the economic costs of smoking. Most studies in developed countries employed a societal perspective, including costs of productivity loss and indirect costs, but not all studies estimated costs associated with second-hand smoking (SHS). The present study estimated the total costs of smoking in Hong Kong including direct and indirect costs attributable to active smoking and to SHS exposure. Our study confirms the pattern of smoking epidemic in developed countries, forewarns the increasing economic burdens from tobacco, and provides East Asian countries with a prediction of their own future costs.
... Six percent to 15 percent of health spending is estimated to go toward tobacco-related diseases in developing countries. 72 The direct cost of treating four major tobacco related diseases in India amounted to United States dollars (USD) 1.2 billion, or 4.7 percent of India's national health care expenditure in 2004. 73 Of course, the adage that the cheapest patient is a dead patient also applies to smoking-related deaths, and indeed some economists have argued that the death of smokers saves money for others in pension schemes. ...
On current consumption patterns, about 400 million adults worldwide will be killed by smoking between 2010 and 2050. Most of these deaths will occur among smokers currently alive. At least half will die at ages 30-69 years, losing decades of productive life. Smoking-attributable mortality has fallen sharply in high-income countries but will rise globally unless today’s smokers, most of whom live in low- and middle-income countries, quit smoking before or during middle age. The single most important intervention to raise cessation rates is a large increase in taxes. Tripling excise taxes on tobacco would raise cessation rates and deter smoking initiation. Higher taxes, regulations on smoking and information for consumers could avoid at least 115 million smoking deaths in the next few decades, including at least 25 million cancer deaths and 50 million vascular deaths.
... A review article by Lightwood et al. (2000) assessed the full economic cost of smoking including the productivity losses from smoking-attributable mortality. They concluded that the total economic costs of smoking represent a significant loss for the wider economy, reaching 2.1-3.4% of GDP in Australia, 1.3-2.2% of GDP in Canada, and 1.4-1.6% of GDP in the US. ...
Tobacco use remains the world's leading cause of preventable death, and is projected to cause over 1 billion deaths in the 21st century, with a disproportionate impact on low- and middle-income countries. This chapter reviews current and emerging evidence on tobacco use and tobacco control efforts worldwide. The chapter explores tobacco prevalence and consumption levels around the globe, trends in tobacco production and international trade, the health and economic consequences of tobacco use among different populations, illicit trade patterns, and the fundamental economic relationship between tobacco taxation, final price and consumer demand. There is a sound evidence base and experience throughout the world that tobacco control measures are effective in reducing the harm caused by tobacco use. Tobacco taxation has proven to be one of the most cost-effective and efficient tobacco demand reduction measures available. Combined with other tobacco control measures such as those recommended in the WHO Framework Convention on Tobacco Control, there is growing optimism that the tobacco epidemic can be reversed and prevented throughout the world. However, tobacco control measures still face challenges from the tobacco industry that require innovative solutions, collaboration and political commitment on the part of governments.
... However , India spends approximately Rs 30,000 crore annually in both public and private spending on the treatment of tobaccorelated illnesses, which accounts for roughly 25% of all public spending on health (Reddy and Gupta 2004). This is much higher than the 6-15% of public spending on health estimated from tobacco-related diseases in other developing countries (Lightwood et al 2000). The direct cost of treating four major tobacco related diseases in India amounted to Rs 54,000 crore or 4.7% of India's national healthcare expenditure in 2004 (John et al 2004). ...
Tobacco smoking of bidis and cigarettes causes about one million deaths a year in India. India's relatively high consumption is due in part to a historically low or no tax on bidis and an inefficient, complex system of taxing cigarettes. In the context of planned tax reforms in India, we provide specific recommendations to raise tobacco taxes and to adopt a simpler and more efficient tax administration that would curb smoking. We estimate that raising the tax as a percentage of retail price from 7% to 33% for bidis and from 43% to 58% for cigarettes would conservatively lead to about 14 million smokers quitting and 27 million children never starting, thereby saving some 69 million years of healthy life over the next 40 years. The increase would also raise about Rs 73 billion or an additional 1.2% of current government revenue, while incurring no or minimal economic harm. Modest action on tobacco taxes in India might well save millions of lives.
... These costs may range from 0.1% to 1.5% of the Gross Domestic Product (GDP) in high-income countries. Furthermore, these costs range from 6% to 15% of national health expenditures 7 . In countries with a less developed economy, such information is more scarcely available, but it is estimated that health care costs are as high as in those countries with industrialized economies 8 . ...
Advances in tobacco control in Brazil can be reflected in the decrease in prevalence over the past two decades. Death statistics and the occurrence of events and direct costs attributable to tobacco-related diseases have not been frequently estimated in the country. The goal of this article is to estimate the burden of smoking in 2011 regarding mortality, morbidity and medical care costs of the main tobacco-related diseases. A probabilistic microsimulation health economic model was built. The model incorporates the natural history, costs and quality of life of all the tobacco-related adult-specific diseases. Smoking was accountable for 147,072 deaths, 2.69 million years of life lost, 157,126 acute myocardial infarctions, 75,663 strokes, and 63,753 cancer diagnoses. The direct cost for the health system was of BRL 23.37 billion. The monitoring of tobacco-related burden is an important strategy to guide decision-makers and to strenghten health public policies.
... De studie werd echter bekritiseerd, omdat bepaalde zorgkosten voor 'levende' rokers worden gemist terwijl deze wel als kostenbesparing in de verloren levensjaren werden meegerekend. Hierdoor zijn de levensloopkosten voor rokers te laag geschat (Sloan et al., 2004;Lightwood et al., 2000). Bovendien werd er alleen gekeken naar uitgaven aan ziekenhuizen en (huis)artsen. ...
... There is an extensive literature on the social costs of smoking. As Lightwood et al. (2000) Viscusi (1995), with adjustments to reflect the lower tar levels of cigarettes smoked by more recent generations of smokers (on the basis that their exposure to harm will have been lower than for the earlier generations whose health experience forms the basis of the cost estimates) and to reflect the lag profile with which this change in tar content feeds through into health effects after consumption. Table 1.2 summarizes some of the key components in the estimates presented by Viscusi, again with total external costs expressed in terms of the externality per pack. ...
Smoking is the single largest cause of avoidable death in the European Union accounting for over half a million deaths each year. One in ten of all 11-year olds have been drunk twice or more times, possibly causing lasting physical and mental harm. Electronic gaming machines are the crack cocaine of gambling. Consumer sovereignty, on the other hand, indicates that people should be allowed to smoke as long as they do not harm others. There is sound medical evidence, furthermore, that a drink each day keeps the doctor away, while recreational gambling can be an enjoyable form of entertainment for many people.These and other salient facts about the harmful and positive effects of smoking, drinking and gambling provide the background for a dispassionate economic analysis of the taxation and regulation of these activities. The main message the studies convey is that it would be unrealistic to rely solely on duty levels and differentiation to curb abusive use. Duty levels do have a clear impact in restraining consumption by children and young adults - an important priority for policy. But complementary policies - including direct regulation and provision of information - also have a meaningful role to play in each of the markets for tobacco, alcohol and gambling.
... Se ha estimado que en los países desarrollados las pérdidas de productividad corresponden aproximadamente a tres veces más los costos médicos directos. 21,22 Otro elemento digno de tomarse en cuenta en el caso de México es la relativa estabilidad de la prevalencia de consumo de tabaco en población adulta, con un incremento en la población general que ha dado como resultado un aumento neto en el número total de fumadores. Este hecho es consistente con lo observado en otros países en desarrollo y su trascendencia radica en que si se mantienen las tendencias actuales, la epidemia del tabaquismo y las enfermedades asociadas se trasladará hacia dichos países, México incluido, incrementando la carga al sistema de salud, así como los costos directos e indirectos. 1 A lo anterior habrá que sumarle el aumento en la prevalencia de consumo de cigarros entre los jóvenes mexicanos, especialmente entre las mujeres. ...
Tobacco smoking as the first cause of preventable dead in the world requires the implementation of proper public poli- cies. The WHO Framework Convention on Tobacco Control (FCTC) sets the basis for this purpose at the national level. But the successful implementation of FCTC depends on a series of actions of every single member of the convention for the development of National Capacity. Building capacity implies the construction of human resources and organizational engineering or "institutional building" in order to enforce and guarantee the Plan of Action for the implementation of FCTC. The creation of the National Office for Tobacco Control of México will allow the enforcement of Mexican government initiatives on implementation of policies for tobacco control, according with FCTC on a sustainable and permanent platform. This essay presents the importance on the office, their main functions and their medium and long term objectives
... There is no need to develop the debate on the harmfulness of cigarette consumption, although the decision on consumption should be free to all individuals. However it is possible to argue about the amount of social costs of cigarette consumption (Pekurinen, 1992;Lightwood et al., 2000). Smokers, however, tend to live shorter lives than non-smokers, which saves on pension payments and healthcare costs of age-related diseases (Shoven et al., 1989). ...
Method of taxation of cigarettes in the European Union brings also many negative effects except stable budgetary income, it discourages from harmful consumption or it takes into account the social costs of smoking. Except value added tax also excise composed of part of specific tax and part of ad valorem tax is there imposed on cigarettes. This causes a significant multiplication distorting the market and impacting the consumers in the case of an increase in the costs of producers of cigarettes. The mechanism of calculation of taxes imposed on cigarettes also causes a creation of a duty to pay taxes on taxes. The significant fact is that indicators measuring these effects between 1995 and 2008 are growing or at least are not declining and neither probable future regulation of harmonization of the taxation of cigarettes in the European Union brings any reparation of the given situation. Taxation of cigarettes is not generally transparent, the rate of taxation is based on inconsistent bases and objectives that should be achieved and probably they are not the priority for many countries of the European Union.
... This argument applies to bar and restaurant visitors and particularly to employees, who might be less free in choice than customers or patrons. Furthermore, the empirical literature suggests smoking bans to reduce the overall consumption of tobacco products (PAK- KO, 2006), which cause significant social costs estimated at 0.1%-1.1% of GDP (LIGHTWOOD et al., 2000). In contrast to increasing taxation of tobacco products, * We thank Johannes Rothmaler for excellent research assistance. ...
Non-smoking ordinances are among the most popular albeit controversial public health-care legislations worldwide. This article provides an empirical assessment of the impact of nonsmoking ordinances on bar and restaurant revenues in German Federal States. By application of a standard panel regression approach and a quasi-experimental research design, we find no compelling evidence for a significant impact of the introduction as well as the weakening of the legislation on revenues of bars and restaurants. Consumption pattern has either not changed at all or any reduction in spending by smokers is compensated for by a corresponding increase by non-smokers. These findings support the German – and similar – non-smoking legislations in the sense that positive externalities resulting from reduced health care cost are likely to outweigh the risk to businesses in the hospitality sector.
This study examines the effects of excise taxes on cigarette prices across EU member states, with a particular focus on the differential impacts of specific and ad valorem excise taxes. EU Directive 2011/64/EU mandates the use of both tax types but allows Member States to determine their relative shares within prescribed limits. Motivated by the need to understand how these taxes influence cigarette prices, the research investigates the extent to which specific and ad valorem taxes are passed through to consumers. Using a panel dataset with annual observations from 28 EU countries between 2010 and 2020, the study applies fixed-effects regression models to evaluate the pass-through effects of these taxes on cigarette prices. The findings reveal that both specific and ad valorem taxes are under-shifted, with ad valorem taxes nearly fully passed on to consumers, resulting in larger price increases, while specific taxes are passed on to a lesser extent, with manufacturers absorbing part of the tax burden. Increasing the share of specific taxes could help stabilize government revenues by minimizing down-trading to cheaper brands, while also reducing smoking prevalence, particularly among price-sensitive groups. The study provides updated insights into the dynamics of cigarette taxation in the EU, offering valuable guidance for policymakers and scholars aiming to optimize tax structures to meet both public health and fiscal goals.
Background
We examined the cost-effectiveness of providing systematic smoking cessation interventions to oncology patients at point-of-care.
Methods
A decision analytic model was completed from the healthcare payer’s perspective and included all incident cancer cases involving patients who smoke in New Brunswick, Canada ( n = 1040), cancer site stratifications, and risks of mortality, continued smoking, and cancer treatment failure over one year. Usual care (no cessation support) was compared to the standard Ottawa Model for Smoking Cessation (OMSC) intervention, and to OMSC plus unlimited cost-free stop smoking medication (OMSC + SSM), including nicotine replacement therapy, varenicline, or bupropion. Primary outcomes were incremental cost per quit (ICQ) and incremental cost per cancer treatment failure avoided (ICTFA).
Results
The ICQ was C1193 for standard OMSC. The ICQ was C5952 for OMSC + SSM. The number needed to treat (NNT) to produce one quit was 9 for standard OMSC and 4 for OMSC + SSM, and the NNT to avoid one first-line treatment failure was 78 for OMSC and 45 for OMSC + SSM. Both were cost-effective in 100% of 1000 simulations.
Conclusions
Given the high clinical benefits and low incremental costs, systematic smoking cessation interventions should be a standard component of first-line cancer treatment.
Aim and Background: In the present study was to find out the prevalence of tobacco consumption and factors contributed for tobacco consumption among males aged 15 years and above in Kanchipuram town. Human beings have been using tobacco since 600 A.D. It was introduced in Europe by Columbus who came to know about it from the Caribbeans during his historical journeys. It was introduced in India by the Portuguese. Materials and Methods: This is Community based cross sectional study was conducted in Kanchipuram town. All the study subjects were explained in detail about the purpose and methodology of the study and were fully assured of strict confidentiality. Informed oral consent was obtained. Personal interview questionnaire is administered and obtained the demographic details and tobacco consumption. Kanchipuram district has been divided into 4 revenue divisions comprising of 11 taluks with 1137 revenue villages. For development reasons, it is divided into 13 development blocks with 648 Village Panchayats. Results: The present study showed a high prevalence of 55.4% tobacco use among male ever users aged 15 years and above in Kanchipuram town. A prevalence of 34% has been noted in male current users of the same age group. Conclusion: In the Present study we conclude that the high prevalence of use of tobacco among males age 15-and above is a major and public health problems. This affects the coming generation also. Hence steps need to be taken right now to tackle this problem.
We studied the association between bone mineral density and (A −1082→G) polymorphism of IL-10 and (A−308→G) polymorphism of TNFα genes. SNP-polymerase chain reaction was used. The study failed to find significant association of A−308→G TNFα polymorphism and bone state in postmenopausal women. The patients with AA genotype of A−1082→G IL-10 gene have significantly lower indices of bone mineral density comparing with G allele carriers (GG/AG). This association remained true for data of bone mineral density of total body, and separate parts of skeleton: lumbar spine, femoral neck, Ward's triangle of total femur. Our study indicates that A−308→G polymorphism of TNFα gene is not associated with indices of bone mineral density in postmenopausal women. However, there is strong evidence that women, carriers of AA genotype of A−1082→G polymorphism of IL-10 gene have significantly lower indices of bone mineral density. This indicates the potential for predictive genetic testing of osteoporosis risk. Analyses of gene combination IL-10 G−1082→G and TNFα G−308→G ('antiinflammatory genotype') did not show any significant association of this genotype with bone characteristics, which shows low predictive value of this combination for diagnostics of osteoporosis.
p> Accumulation of funds to cover government spending is the primary purpose of taxation. According to multiple authors, excise duties are classified as taxes with the highest revenue-raising potential. In the OECD member states, e xcise duties constitute a considerable source of state revenue. They account on average for 7.6% of total taxation. The European Union member states apply a harmonized structure for excise duties on selected products. They include, above all, alcoholic beverages and tobacco products. The average share of alcohol and tobacco taxation in GDP and total taxation for EU-28 in 2014 equaled, respectively, 0.8% and 2.2%. Although taxes on alcohol and tobacco are in no small extent harmonized, their design may sill vary between member states and strongly affect their collection efficiency. The primary purpose of this article is to compare excise duties imposed on alcohol and tobacco in Germany and Poland. The article is divided into three parts. The first addresses theoretical aspects concerning excise taxation. The second reviews the design of alcohol and tobacco excise duties in Germany and Poland. The third evaluates the revenue-raising potential of these duties in both countries. </p
This chapter discusses the bioethical basis for cooperative approaches to the global tobacco epidemic. It discusses the use of legal instruments to address global public health threats and the ethical basis for implementation of acts for smoking cessation. In addition, the aims are to describe the major ethical issues surrounding tobacco taxation and to identify policy responses to minimize any ethical dilemmas.
Active and passive smoking cause a range of health and social problems that have associated economic costs. These costs are borne by a range of individuals and institutions in any society. The smoker bears the costs of ill-health and reduced length of life. Smoking-related illnesses may also have an impact on earnings. Families also bear a number of costs including the impact of secondhand smoke in the home on partners and particularly children and the unborn. The costs of care for smoking-related illness including lung cancer may fall partly on the families, other tax payers, or employers depending on the financing of the healthcare system. There are also considerable other costs associated with smoking in the workplace, including reduced productivity, smoking-related fires, and cleaning costs.
In this chapter, the most recent literature on cognitive behavioral therapy interventions for the treatment of tobacco dependence is reviewed. Evidence was compiled primarily from meta-analyses, Cochrane Reviews, and recent qualitative review papers focused on the efficacy of various cognitive behavioral therapy approaches for achieving tobacco abstinence. Emphasis is given to the literature pertaining to general cognitive behavioral therapy approaches for smoking cessation as well as newer extensions of cognitive behavioral therapy including mindfulness-based approaches and relapse prevention. The evidence in this review indicates that cognitive behavioral therapy-based interventions are effective at increasing rates of tobacco abstinence in the general population, in special populations, and in individuals with comorbid psychological disorders such as depression. Recent studies examining extensions of cognitive behavioral therapy such as mindfulness-based urge surfing interventions and relapse prevention models suggest that these techniques may also hold promise for increasing the likelihood of a successful quit attempt. Finally, a growing body of evidence indicates that pairing certain types of pharmacotherapy for smoking cessation with cognitive behavioral therapy may be more efficacious than pharmacotherapy alone. Overall, the clinical literature on smoking cessation indicates that cognitive behavioral therapy-based interventions are an effective therapeutic option in the treatment of tobacco dependence.
Background:
Ischemic heart disease (IHD) is the leading cause of death worldwide. The GBD (Global Burden of Disease, Injuries, and Risk Factors) study (GBD 2010 Study) conducted a systematic review of IHD epidemiology literature from 1980 to 2008 to inform estimates of the burden on IHD in 21 world regions in 1990 and 2010.
Methods:
The disease model of IHD for the GBD 2010 Study included IHD death and 3 sequelae: myocardial infarction, heart failure, and angina pectoris. Medline, EMBASE, and LILACS were searched for IHD epidemiology studies in GBD high-income and low- and middle-income regions published between 1980 and 2008 using a systematic protocol validated by regional IHD experts. Data from included studies were supplemented with unpublished data from selected high-quality surveillance and survey studies. The epidemiologic parameters of interest were incidence, prevalence, case fatality, and mortality.
Results:
Literature searches yielded 40,205 unique papers, of which 1,801 met initial screening criteria. Upon detailed review of full text papers, 137 published studies were included. Unpublished data were obtained from 24 additional studies. Data were sufficient for high-income regions, but missing or sparse in many low- and middle-income regions, particularly Sub-Saharan Africa.
Conclusions:
A systematic review for the GBD 2010 Study provided IHD epidemiology estimates for most world regions, but highlighted the lack of information about IHD in Sub-Saharan Africa and other low-income regions. More complete knowledge of the global burden of IHD will require improved IHD surveillance programs in all world regions.
The panel and the Appellate Body have recently examined one of the national tobacco control measures (US – Measures Affecting the Productions and Sale of Clove Cigarettes). The dispute, which emerged between the United States and Indonesia, concerned the US ban on the use of certain flavouring additives in cigarettes. The reports are particularly important because they clarify the limits existing under the TBT Agreement in this policy space. This paper critically analyses findings of the WTO dispute settlement bodies and assesses their broader implications for national tobacco control regulations. In particular, it examines the extent to which the rules of the TBT Agreement, as interpreted in the Clove dispute, constrain national governments and to what extent they affect various national initiatives that are currently discussed in the TBT Committee (e.g. Brazilian measure on the use of additives in cigarettes).
About this series... This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank's Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual authors whose name appears on the paper. Enquiries about the series and submissions should be made directly to the Managing Editor Nicole Klingen (Nklingen@worldbank.org) or HNP Advisory Service (healthpop@worldbank.org, tel 202 473-2256, fax 202 522-3234). For more information, see also www.worldbank.org/ hnppublications.
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