School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
SA Centre for Economic Studies, University of Adelaide, Adelaide, SA, Australia.
Nicotine Tob Res. 2020 Apr 17;22(4):458-465. doi: 10.1093/ntr/ntz038.
To identify studies reporting costs arising from tobacco use and detail their (1) economic approaches, (2) health outcomes, and (3) other cost areas included.
We searched PubMed, Scopus, Cochrane Library, EconLit, and Google Scholar for studies published between 2008 and April 2018 in English. Eligible articles reported tobacco-related costs and included all tobacco-using populations (multinational, national, subpopulations, and involuntary smokers). All economic approaches that resulted in monetary outcomes were included. We reported USD or converted local currencies to USD. Two health economists extracted and two researchers independently reviewed the data.
From 4083 articles, we reviewed 361 abstracts and examined 79 full-texts, with 63 (1.6%) deemed eligible. There were three multinational, thirty-four national, twenty-one subpopulation or condition(s)-specific analyses, and five evaluating involuntary smoking. The diverse approaches and outcomes precluded integrating costs, but these were substantial in all studies. For instance, about USD 1436 billion in global health expenditures and productivity losses in 2012 and USD 9 billion in lost productivity in China, Brazil, and South Africa in 2012. At the national level, costs ranged from USD 4665 in annual per respondent health expenses (Germany 2006-2008) to USD 289-332.5 billion in medical expenses (United States 1964-2014).
Despite wide variations in the methods used, the identified costs of tobacco are substantial. Studies on tobacco cost-of-illness use diverse methods and hence produce data that are not readily comparable across populations, time, and studies, precluding a consistent evidence-base for action and measurement of progress. Recommendations are made to improve comparability.
In addition to the health and financial costs to individual smokers, smoking imposes costs on the broader community. Production of comparable estimates of the societal cost of tobacco use is impaired by a plethora of economic models and inconsistently included costs and conditions. These inconsistencies also cause difficulties in comparing relative impacts caused by differing factors. The review systematically documents the post-2007 literature on tobacco cost-of-illness estimations and details conditions and costs included. We hope this will encourage replication of models across settings to provide more consistent data, able to be integrated across populations, over time, and across risk factors.
本研究旨在确定报告烟草使用相关成本的研究，并详细说明其（1）经济方法、（2）健康结果和（3）包含的其他成本领域。
我们在 PubMed、Scopus、Cochrane Library、EconLit 和 Google Scholar 中检索了 2008 年至 2018 年 4 月期间发表的英文文献。符合条件的文章报告了与烟草相关的成本，并包括所有使用烟草的人群（跨国、国家、亚人群和非自愿吸烟者）。所有产生货币结果的经济方法都包括在内。我们报告了美元或换算成当地货币的美元。两名健康经济学家提取数据，两名研究人员独立审查数据。
从 4083 篇文章中，我们回顾了 361 篇摘要，并检查了 79 篇全文，其中 63 篇（1.6%）被认为符合条件。有三篇是跨国研究，34 篇是国家研究，21 篇是亚人群或特定条件的分析，还有五篇是评估非自愿吸烟的研究。不同的方法和结果使得难以整合成本，但所有研究中的成本都相当可观。例如，2012 年全球卫生支出和生产力损失约为 14360 亿美元，2012 年中国、巴西和南非的生产力损失为 90 亿美元。在国家层面，每年每个受访者的健康支出成本从德国 2006-2008 年的 4665 美元到美国 1964-2014 年的 289-332.5 亿美元不等。
尽管所使用的方法存在广泛差异，但已确定的烟草成本相当可观。关于疾病成本的研究使用了不同的方法，因此在人群、时间和研究之间产生的数据不具有可比性，无法为行动提供一致的证据基础，也无法衡量进展情况。我们提出了改进可比性的建议。
除了对个体吸烟者的健康和经济成本外，吸烟还对更广泛的社区造成成本。由于大量的经济模型以及不一致的包含成本和条件，生产可比的烟草使用社会成本估计受到阻碍。这些不一致也导致了由于不同因素造成的相对影响的比较困难。本综述系统地记录了 2007 年后关于烟草疾病成本估算的文献，并详细说明了所包含的条件和成本。我们希望这将鼓励在不同环境下复制模型，以提供更一致的数据，能够在人群、时间和风险因素之间进行整合。
