Centre for Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash Univeristy, Melbourne, Victoria, Australia.
Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Tob Control. 2019 May;28(3):297-304. doi: 10.1136/tobaccocontrol-2018-054263. Epub 2018 Jul 16.
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.
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.
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 $A157 000 (GDP per EFT worker in 2016), the economic impact of lost productivity would amount to $A388 billion.
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.
本研究旨在考察吸烟对澳大利亚生产力的影响，具体表现在丧失的生命年、丧失的质量调整生命年（QALY）和新颖的生产力调整生命年（PALY）丧失方面。
利用当代澳大利亚数据进行寿命表建模，模拟当前年龄在 20-69 岁的吸烟者到 70 岁的随访情况。超额死亡率、与健康相关的生活质量下降以及归因于吸烟的生产力相对下降的数据来源于已发表的资料。使用澳大利亚 2016 年每个同等全职（EFT）工人的国内生产总值（GDP）来估算归因于吸烟的生产力损失的人群水平成本。
目前，约有 250 万澳大利亚人（17.4%）年龄在 20 至 69 岁之间吸烟。假设对这部分人群进行随访直到 70 岁，将有超过 310 万年的生命因吸烟而丧失，600 万质量调整生命年和 250 万生产力调整生命年。这相当于澳大利亚工作年龄吸烟者丧失的 4.2%的生命年、9.4%的 QALY 和 6.0%的 PALY。在个体层面，这相当于每个吸烟者丧失 1.2 年的生命、2.4 个 QALY 和 1.0 个 PALY。假设（保守起见）每个澳大利亚的 PALY 价值为 157000 澳元（2016 年每个 EFT 工人的 GDP），则因生产力丧失造成的经济损失将达到 3880 亿澳元。
本研究强调了通过在澳大利亚实施进一步的控烟措施，使用 PALY 可以获得潜在的健康和生产力收益，这是一种新颖且易于估算的衡量健康和健康风险因素对工作生产力影响的指标。
