Smoking is a major avoidable cause of morbidity and mortality in the UK, with smoking related deaths estimated at over 100,000 per year. In 2005, the direct annual cost to the NHS in England due to smoking related conditions was estimated to be £4.4 billion, which was equal to 6.5% of the total health care budget for England.
Few attempts have been made to model the long-term costs and health consequences of smoking and there is a clear need for a model for England based on population-specific data. The model developed for this project is based on Markov framework that uses adult cohorts of non-smokers, smokers and ex-smokers to estimate lifetime health care costs and health consequences for the population of England. The model explicitly evaluates smoking-related risk on incidence and disease pathways for myocardial infarction, stroke, chronic obstructive pulmonary disease and lung cancer. Increased risk of other smoking-related morbidities is also incorporated in the model.
The model shows that smoking is associated with increased lifetime health care costs and reduced life-years lived. For a cohort of 1,000 men aged 35 years, the lifetime direct healthcare cost attributable to smoking is estimated to be £8.6 million (women: £7.8 million). With regards to life years lost, in a cohort of 1,000 smokers (35 year old), smoking would lead to lifetime loss of 6,610 years (women: 6,521 years). The model also estimates that if all current smokers in England continued smoking, the lifetime direct healthcare cost of smoking for the prevalent smoker male population of England (aged 35 years and over) will be £23.3 billion (women: £21.4 billion).
Smoking cessation reduces the costs of health resource use as the number of years since quitting increase. The model estimates that the lifetime health care cost savings from smoking cessation for a cohort of 1,000 men (35 year old) are £4.9 million (women: £4.8 million). In terms of life year gain in the same cohort, smoking cessation would result in a gain of 4,262 years (women: 4,534 years). These benefits in health consequences will result in significant cost savings for the NHS.
The economic model developed for this project can be used as a decision tool by policy-makers who will be able to estimate the impact of smoking cessation and smoking prevention interventions in terms of cost savings and life years saved.