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Evaluation of the economic impact of California's Tobacco Control Program: a dynamic model approach
  1. Leonard S Miller1,
  2. Wendy Max2,
  3. Hai-Yen Sung2,
  4. Dorothy Rice2,
  5. Malcolm Zaretsky3
  1. 1School of Social Welfare, University of California, Berkeley, California, USA
  2. 2Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
  3. 3Department of Molecular and Cell Biology, University of California, Berkeley, California, USA
  1. Correspondence to Wendy Max, Institute for Health & Aging, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, CA 94118, USA; wendy.max{at}


Objective To evaluate the long-term net economic impact of the California Tobacco Control Program.

Methods This study developed a series of dynamic models of smoking-caused mortality, morbidity, health status and healthcare expenditures. The models were used to evaluate the impact of the tobacco control programme. Outcomes of interest in the evaluation include net healthcare expenditures saved, years of life saved, years of treating smoking-related diseases averted and the total economic value of net healthcare savings and life saved by the programme. These outcomes are evaluated to 2079. Due to data limitations, the evaluations are conducted only for men.

Results The California Tobacco Control Program resulted in over 700 000 person-years of life saved and over 150 000 person-years of treatment averted for the 14.7 million male California residents alive in 1990. The value of net healthcare savings and years of life saved resulting from the programme was $22 billion or $107 billion in 1990 dollars, depending on how a year of life is discounted. If women were included, the impact would likely be much greater.

Conclusions The benefits of California's Tobacco Control Program are substantial and will continue to accrue for many years. Although the programme has resulted in increased longevity and additional healthcare resources for some, this impact is more than outweighed by the value of the additional years of life. Modelling the programme's impact in a dynamic framework makes it possible to evaluate the multiple impacts that the programme has on life, health and medical expenditures.

  • Cost of smoking
  • healthcare expenditures
  • California Tobacco Control Program
  • economics
  • public policy

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Funding This research was funded by the California Tobacco-Related Disease Research Program under grant 9RT-0157. The grant was awarded competitively and the funding agency was not involved in any aspect of the research.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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