Economic costs attributable to secondhand smoke: A review of the literature

Objective: National estimates of societal costs of secondhand smoke (SHS) are not available. Our purpose was to review the literature and determine what gaps need to be addressed to estimate societal costs attributable to secondhand smoke exposure. Methods: A systematic review of peer-reviewed publications on costs attributable to secondhand smoke. Searches were conducted on EconLit, PubMed, ScienceDirect, and JSTOR. Results: 484 articles were identified and 25 selected for inclusion in the review. Studies differed by study populations, cost outcomes, SHS-related diseases, and time periods of analysis. Outcomes included: medical costs, costs of life lost, lost productivity costs, and costs paid by government, insurance companies, or individuals. Medical costs included inpatient, outpatient and physician consultations. The two main types of analytical methods used to estimate costs were attributable fraction approaches (72%) and regression-based approaches (20%). All studies found sizeable annual costs attributable to SHS exposure and/or savings from implementation of smoke-free policies. While a large number of SHS-related outcomes have been studied, most studies lacked estimates of indirect costs attributable to SHS exposure (i.e., productivity losses, loss of life). Also, comprehensive direct cost estimates existed for only a limited number of states. Conclusions: We found a wide variation in outcomes, study populations and time periods studied. More studies on the indirect costs of SHS are needed to produce societal cost estimates at both the national and state-levels.