Connolly Mark P, Baker Christine L, Kotsopoulos Nikolaos
a Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy , University of Groningen , The Netherlands.
b Global Market Access Solutions , St-Prex , Switzerland.
J Med Econ. 2018 Jun;21(6):571-576. doi: 10.1080/13696998.2018.1434183. Epub 2018 Feb 13.
Smoking gives rise to many cross-sectorial public costs and benefits for government. Costs arise from increased healthcare spending and work-related social benefits, while smoking itself provides significant revenue for government from tobacco taxes. To better understand the public economic impact of smoking and smoking cessation therapies, this study developed a government perspective framework for assessing smoking-attributable morbidity and mortality and associated public costs. This framework includes changes in lifetime tax revenue and health costs, as well as changes in tobacco tax revenue, from fewer smokers.
A modified generational accounting framework was developed to assess relationships between smoking-attributable morbidity and mortality and public economic consequences of smoking, including lifetime tax revenue gains/losses, government social transfers, and health spending. Based on the current prevalence of smoking in South Korean males, a cohort model was developed for smokers, former-smokers, and never-smokers. The model simulated the lifetime discounted fiscal transfers for different age cohorts in 5 year age bands, and the return on investment (ROI) from smoking cessation therapy.
Former smokers are estimated to generate higher lifetime earnings and direct tax revenues and lower lifetime healthcare costs due to the reduction of smoking-attributable mortality and morbidity compared to smokers, even after accounting for reduced tobacco taxes paid. Based on the costs of public investments in varenicline, this study estimated a ROI from 1.4-1.7, depending on treatment age, with higher ROI in younger cohorts, with an average ROI of 1.6 for those aged less than 65.
This analysis suggests that reductions in smoking can generate positive public economic benefits for government, even after accounting for lost tobacco tax revenues. The results described here are likely applicable to countries having similar underlying smoking prevalence, comparable taxation rates, and social benefit protection provided to individuals with smoking-related conditions.
吸烟给政府带来了诸多跨部门的公共成本与收益。成本源于医疗支出增加及与工作相关的社会福利，而吸烟本身通过烟草税为政府带来可观收入。为更好地理解吸烟及戒烟疗法对公共经济的影响，本研究构建了一个从政府视角评估吸烟所致发病率和死亡率及相关公共成本的框架。该框架包括因吸烟者减少导致的终身税收收入和健康成本的变化，以及烟草税收入的变化。
开发了一种改良的世代核算框架，以评估吸烟所致发病率和死亡率与吸烟的公共经济后果之间的关系，包括终身税收收入的增减、政府社会转移支付和医疗支出。基于韩国男性当前的吸烟流行率，为吸烟者、曾经吸烟者和从不吸烟者建立了一个队列模型。该模型模拟了不同年龄组（每5岁为一组）的终身贴现财政转移支付，以及戒烟疗法的投资回报率（ROI）。
据估计，与吸烟者相比，曾经吸烟者因吸烟所致死亡率和发病率降低，即使扣除所缴纳的烟草税减少，其终身收入和直接税收收入更高，终身医疗成本更低。基于伐尼克兰的公共投资成本，本研究估计投资回报率在1.4至1.7之间，具体取决于治疗年龄，年轻队列的投资回报率更高，65岁以下人群的平均投资回报率为1.6。
该分析表明，即使扣除烟草税收入损失，吸烟率的降低也能为政府带来积极的公共经济效益。此处描述的结果可能适用于具有相似潜在吸烟流行率、可比税率以及为患有吸烟相关疾病的个人提供的社会福利保护的国家。
