Volume 184 - Issue 1
Hospitalisation and costs attributable to tobacco smoking in Australia: 2001–2002
Author: Susan F Hurley
Med J Aust 2006; 184 (1): 45. || doi: 10.5694/j.1326-5377.2006.tb00102.x
Published online: 2 January 2006
Published online: 2 January 2006
Susan F Hurley
Associate Professor, School of Population Health, University of Melbourne; and Health Economics Consultant, Bainbridge Consultants, 532 Brunswick St, North Fitzroy, VIC 3068. susanhurleyATbainbridgeconsultants.com
To the Editor: Previous analyses of costs to the Pharmaceutical Benefits Scheme and costs for stroke and acute myocardial infarction hospitalisations suggest that tobacco control programs are a good investment.1,2 To further highlight the economic benefits of reducing smoking rates, I estimated the hospitalisation costs attributable to cigarette smoking in Australia for 2001–2002 by applying aetiological fractions to hospitalisation data.3
Aetiological fractions were calculated using 2001 National Health Survey smoking prevalence data and relative risks of hospitalisation for current and former smokers, as previously calculated by English and colleagues through linkage of data from the Busselton health survey and the Western Australian Hospital Morbidity Data system.4 Counts of separations (hospitalisations), bed-days, and average costs for hospitalisations in Australia in 2001–2002, by sex and 5-year age category, were obtained from the Australian Institute of Health and Welfare. They had been sourced from the National Hospital Morbidity Database (http://www.aihw.gov.au/hospitals/nhm_database.cfm) and the National Hospital Cost Data Collection (http://www.health.gov.au/casemix), linked by the common variable “DRG4.2”.
The results (Box) show that, in 2001–2002, almost 300 000 hospitalisations, costing $682 million, were attributable to cigarette smoking.
English and colleagues estimated previously that, in 1992, 129 000 hospital separations and over 1.1 million bed-days were attributable to cigarette smoking.4 Although the proportion of the Australian population who are smokers has decreased since then, from 26% to 23% in 2001,5 cigarette smoking is still associated with substantial health care utilisation and costs.
The actual costs are even greater than the $682 million per annum estimated by my analysis, as the following were not considered: hospitalisation costs for those aged 80 years and over; pharmaceutical costs (estimated at $126 million for cardiovascular drugs on the Pharmaceutical Benefits Scheme1); community care costs (such as general practitioner visits); and patient contributions to hospitalisation costs.
In stark contrast to the $682 million spent on hospitalisations attributable to smoking, the Australian Government has committed an average of only $2 million per year over the last 10 years to tobacco harm minimisation programs.6
Hospitalisations, bed-days and costs attributable to cigarette smoking in Australia in 2001–2002*
|
Hospitalisations |
Bed-days |
Costs† |
||||||||||||
|
Proportion |
Number |
Proportion |
Number |
Proportion |
$ (millions) |
|||||||||
Men |
7.6% |
138 000 |
14.6% |
891 000 |
7.6% |
$339 |
|||||||||
Women |
8.6% |
153 000 |
9.8% |
581 000 |
8.6% |
$342 |
|||||||||
Total |
8.1% |
291 000 |
12.2% |
1 472 000 |
8.1% |
$682 |
|||||||||
* For people aged 40–79 years. † Estimated costs are conservative, as they are based on average cost per hospitalisation for the total population. However, the higher proportion of bed-days than hospitalisations attributable to smoking suggests smokers tend to have longer stays and thus higher than average costs. |
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Acknowledgements
This research was supported with funding from the Victorian Health Promotion Foundation and The Cancer Council Victoria. These funding bodies, per se, had no role in the design, conduct or interpretation of the study. I am a consultant to The Cancer Council Victoria. Dallas English provided advice on the methodology used by English et al.4
References
- Hurley SF, Scollo MM, Younie SJ, et al. The potential for tobacco control to reduce PBS costs for smoking-related cardiovascular disease. Med J Aust 2004; 181: 252-255.
- Hurley SF. Short-term impact of smoking cessation on myocardial infarction and stroke hospitalisations and costs in Australia. Med J Aust 2005; 183: 13-17. 0_i1091647
- English DR, Holman CD, Milne E, et al. The quantification of drug caused morbidity and mortality in Australia 1995. Canberra: Department of Human Services and Health, 1995. 0_i1091649
- English DR, Vu HTV, Knuiman MW. The impact of smoking on use of hospital services: the Busselton study. Aust N Z J Public Health 2002; 26: 225-230. 0_i1091651
- White V, Hill D, Siahpush M, Bobevski I. How has the prevalence of cigarette smoking changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tobacco Control 2003; 12 (Suppl II): ii67-ii74. 0_i1091655
- VicHealth Centre for Tobacco Control. Tobacco control: a blue chip investment in public health. Melbourne: VicHealth Centre for Tobacco Control, 2003. Available at: http://www.vctc.org.au/publ/reports/TC_S1April2003.pdf (accessed Aug 2005).