The costs of smoking and the cost effectiveness of smoking-cessation programs.

The impact of cigarette smoking on morbidity and mortality in this country is enormous. It is the cause of one out of every six deaths in the U.S., and is linked to conditions ranging from cardiovascular disease to cancer to low-birth weight. Economic analyses indicate that cessation of cigarette smoking will probably not lead to reduced health care expenditures in the general population because of increased health care utilization during those years of life saved as a result of cessation. However, when indirect costs (economic productivity) are taken into account, cessation of cigarette smoking appears to be cost saving. In addition, for particular subgroups (such as pregnant women and post-myocardial infarction patients), there may be health-care cost savings. Cost-effectiveness analyses of smoking cessation methods are reviewed. A relatively narrow range of smoking cessation methods has been evaluated for cost effectiveness. There is some evidence that cost-effective smoking cessation programs are tailored to the target population and consist of multiple interventions with reinforcement of the cessation techniques or messages. Equity considerations demand that smoking cessation programs not be chosen simply on the basis of their cost effectiveness because it is likely that certain groups (such as minorities or heavy smokers) will not be targeted. Some potentially efficacious smoking cessation methods such as bans on smoking in public places and excise taxes are not easily assessable using cost-effectiveness methodology.