ABSTRACT
Background Although smoking cessation is de-
sirable from a public health perspective, its conse-
quences with respect to health care costs are still
debated. Smokers have more disease than nonsmok-
ers, but nonsmokers live longer and can incur more
health costs at advanced ages. We analyzed health
care costs for smokers and nonsmokers and esti-
mated the economic consequences of smoking ces-
sation.
Methods We used three life tables to examine the
effect of smoking on health care costs — one for a
mixed population of smokers and nonsmokers, one
for a population of smokers, and one for a popula-
tion of nonsmokers. We also used a dynamic meth-
od to estimate the effects of smoking cessation on
health care costs over time.
Results Health care costs for smokers at a given
age are as much as 40 percent higher than those for
nonsmokers, but in a population in which no one
smoked the costs would be 7 percent higher among
men and 4 percent higher among women than the
costs in the current mixed population of smokers
and nonsmokers. If all smokers quit, health care
costs would be lower at first, but after 15 years they
would become higher than at present. In the long
term, complete smoking cessation would produce a
net increase in health care costs, but it could still be
seen as economically favorable under reasonable
assumptions of discount rate and evaluation period.
Conclusions If people stopped smoking, there
would be a savings in health care costs, but only in
the short term. Eventually, smoking cessation would
lead to increased health care costs. (N Engl J Med
1997;337:1052-7.)
©1997, Massachusetts Medical Society.
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