Economic burden of smoking and secondhand smoke exposure in Taiwan, 2010

The objective of this study was to assess the direct and indirect costs attributable to smoking and secondhand smoke (SHS) exposure in Taiwan for persons aged 35 or older in 2010. We considered 19 active smoking-related diseases and six SHS-associated diseases. Smoking prevalence and SHS exposure rates were determined using data from the 2010 Taiwan Adult Smoking Behavior Survey. Direct costs included healthcare expenditures paid by Taiwan’s National Health Insurance (NHI) Program for two types of health services: hospitalizations, and ambulatory care visits. Indirect costs were defined as the value of lost productivity due to smoking-attributable premature deaths and the value of time lost from work due to smoking-related illness. Epidemiological mortality ratio approach was used to estimate active or passive smoking-attributable fractions (SAFs) for each type of health services and indirect costs. The SAFs were applied to healthcare expenditures, workloss days, and deaths to obtain smoking-attributable total measures. In 2010, the direct costs of smoking and SHS exposure in Taiwan amounted to US$828 million, accounting for 6% of Taiwan’s NHI Program spending. While direct costs of active smoking were much higher for men (US$702 million) than women (US$39 million), women had higher direct costs of SHS exposure than men (US$47 million versus US$39 million). Indirect costs amounted to US$840 million. Although smoking prevalence and SHS exposure in Taiwan have declined in recent years, smoking still imposes a huge financial burden in Taiwan. Continued tobacco control efforts to sustain reduction in smoking and SHS exposure are needed.