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Original research
Economic burden of lung cancer attributable to smoking in China in 2015
  1. Ju-Fang Shi1,
  2. Cheng-Cheng Liu1,
  3. Jian-Song Ren1,
  4. Mark Parascandola2,
  5. Rong Zheng3,
  6. Wei Tang4,
  7. Hui-Yao Huang1,
  8. Fang Li5,
  9. Le Wang1,
  10. Kai Su5,
  11. Ni Li1,
  12. Kai Zhang6,
  13. Wan-Qing Chen1,
  14. Ning Wu4,
  15. Xiao-Nong Zou7,
  16. Guo-Xiang Liu8,
  17. Min Dai1
  1. 1 Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2 Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Washington DC, United States
  3. 3 School of International Trade and Economics, University of International Business and Economics, Beijing, China
  4. 4 Department of Diagnostic Radiology, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  5. 5 Department of Thoracic Surgery, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  6. 6 Department of Medical Examination for Cancer Prevention, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  7. 7 Office for Cancer Registry, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  8. 8 Department of Health Economics, School of Public Health, Harbin Medical University, Harbin, China
  1. Correspondence to Min Dai, Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; daimin2002{at}hotmail.com; Guo-Xiang Liu, Department of Health Economics, School of Public Health, Harbin Medical University, Harbin, China; lgx6301{at}163.com; Xiao-Nong Zou, Office for Cancer Registry, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; xnzou{at}126.com

Abstract

Background Lung cancer is substantially attributable to smoking, but detailed related estimates on smoking-attributable expenditure (SAE) in China are not available yet, which could inform tobacco control and cancer prevention initiatives.

Methods A prevalence-based approach was adopted to estimate the total SAE, including direct expenditure (medical and non-medical) and indirect cost (disability and premature death). Detailed per-patient data on direct expenditure and work-loss days were acquired from a unique multicentre survey in China. Other parameters were from literatures and official reports.

Results The total estimated SAE of lung cancer was US$5249 million in China in 2015 (0.05 % of gross domestic product for China). The estimated direct SAE was US$1937 million (36.9 % of the total SAE), accounting for 0.29 % of total healthcare expenditure for China. The medical and non-medical direct expenditures were US$1749 million and US$188 million, respectively. The estimated indirect cost was US$3312 million (63.1 % of the total SAE), including US$377 million due to disability and US$2935 million due to premature death. The SAE increased with age, peaking at 60–64 years (US$1004 million), and was higher among men, in urban areas and in eastern China. If smoking prevalence was reduced to 20%, as is the goal of Healthy China 2030, the total SAE would be decreased by 4.9 %.

Conclusions Smoking-attributable economic burden caused by lung cancer was substantial in China in 2015, and will continue increasing given current trends in lung cancer. However, future economic burden can be prevented with implementation of effective tobacco control and other interventions.

  • economics
  • smoking caused disease
  • public policy

https://doi.org/10.1136/tobaccocontrol-2018-054767

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    Footnotes

    • J-FS, C-CL and J-SR contributed equally.

    • Contributors MD, J-FS, G-XL and X-NZ conceived the research idea. WT, H-YH, FL, LW, KS, NL, KZ and WC conducted the data collection and quality control. C-CL, H-YH and LW performed data analysis. MP, RZ and NW were responsible for data interpretation. J-FS, C-CL and J-SR performed the writing and drafting of the manuscript. MD, J-FS, G-XL and X-NZ did the critical revision of the manuscript for important intellectual content. All authors have read the manuscript and have agreed to this submission.

    • Funding This study was supported by the National Key R&D Program of China (2017YFC1308700 / 2017YFC1308705); the National Natural Science Foundation of China (81773521); the National Key R&D Program of China (2017YFC0907900 / 2017YFC0907901, 2017YFC0211704); the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (2018RC330001); the National Key Public Health Program of China (Cancer Screening Program in Urban China).

    • Competing interests None declared.

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