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Tobacco Control 2006;15:464-471; doi:10.1136/tc.2006.016030
Copyright © 2006 by the BMJ Publishing Group Ltd.

RESEARCH PAPER

Mortality, morbidity and costs attributable to smoking in Germany: update and a 10-year comparison

Simone Neubauer1, Robert Welte1, Alexandra Beiche2, Hans-Helmut Koenig3, Katharina Buesch1 and Reiner Leidl1

1 GSF-National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
2 Department of Surgery, General Hospital Laupheim, Laupheim, Germany
3 Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany

Correspondence to:
Correspondence to:
S Neubauer
GSF-National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany; simone.neubauer{at}gsf.de

Objective: To assess the negative health consequences and associated costs of cigarette smoking in Germany in 2003 and to compare them with the respective results from 1993.

Methods: The number of deaths, years of potential life lost (YPLL), direct medical and indirect costs caused by active cigarette smoking in Germany in 2003 is estimated from a societal perspective. The method is similar to that applied by Welte et al, who estimated the cost of smoking in Germany in 1993. Therefore, a direct comparison of the results was possible. Methodological and data differences between these two publications and their effect on the results are analysed.

Results: In 2003, 114 647 deaths and 1.6 million YPLL were attributable to smoking. Total costs were {euro}21.0 billion, with {euro}7.5 billion for acute hospital care, inpatient rehabilitation care, ambulatory care and prescribed drugs; {euro}4.7 billion for the indirect costs of mortality; and {euro}8.8 billion for costs due to work loss days and early retirement. From 1993 to 2003, the proportionate mortality attributable to smoking remained relatively stable, rising from 13.0% to 13.4%. The smoking-attributable deaths in men is lowered by 13.7% whereas that in women increased by 45.3%. Total real direct costs rose by 35.8%, and total real indirect costs declined by 7.1%, rendering an increase of 4.7% to real total costs. Accountable factors are changes in cigarette smoking prevalence and in disease-specific mortality and morbidity, as well as a rise in general healthcare expenditure.

Conclusions: Despite the growing knowledge about the hazards of smoking, the smoking-attributable costs increased in Germany. Further, female mortality attributable to smoking is much higher than it was in 1993.

Abbreviations: CPS, Cancer Prevention Survey; ICD, International Classification of Diseases; SAF, smoking-attributable fraction; YPLL, years of potential life lost


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