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Twenty-year health and economic impact of reducing cigarette use: Minnesota 1998–2017
  1. Michael V Maciosek1,
  2. Amy B LaFrance1,
  3. Ann St Claire2,
  4. Zack Xu1,
  5. Morgan Brown1,
  6. Barbara A Schillo2
  1. 1HealthPartners Institute, Minneapolis, Minnesota, USA
  2. 2ClearWay Minnesota, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Michael V Maciosek, HealthPartners Institute, Minneapolis, MN 55440-1524, USA; michael.v.maciosek{at}


Background Adult smoking prevalence in Minnesota fell from 21.8% in 1997 to 15.2% in 2016. This reduction improved heart and lung health, prevented cancers, extended life and reduced healthcare costs, but quantifying these benefits is difficult.

Methods 1.3 million individuals were simulated in a tobacco policy model to estimate the gains to Minnesotans from 1998 to 2017 in health, medical spending reductions and productivity gains due to reduced cigarette smoking. A constant prevalence scenario was created to simulate the tobacco harms that would have occurred had smoking prevalence stayed at 1997 levels. Those harms were compared with tobacco harms from a scenario of actual smoking prevalence in Minnesota from 1998 to 2017.

Results The simulation model predicts that reducing cigarette smoking from 1998 to 2017 has prevented 4560 cancers, 31 691 hospitalisations for cardiovascular disease and diabetes, 12 881 respiratory disease hospitalisations and 4118 smoking-attributable deaths. Minnesotans spent an estimated $2.7 billion less in medical care and gained $2.4 billion in paid and unpaid productivity, inflation adjusted to 2017 US$. In sensitivity analysis, medical care savings ranged from $1.7 to $3.6 billion.

Conclusions Minnesota’s investment in comprehensive tobacco control measures has driven down smoking rates, saved billions in medical care and productivity costs and prevented tobacco related diseases of its residents. The simulation method employed in this study can be adapted to other geographies and time periods to bring to light the invisible gains of tobacco control.

  • economics
  • prevention
  • public policy

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  • Contributors ABF and MVM drafted the bulk of the manuscript. BAS and AWS conceived the study. MB, MVM and ZX developed and implemented the analysis plan.All authors critically reviewed the manuscript.

  • Funding This study was supported by ClearWay Minnesota. Coauthors employed by ClearWay Minnesota (BAS and AWS) conceptualised the study, and participated in interpreting results and revising the manuscript.

  • Competing interests MVM, ABS, XZ and MB received support for this work through a research contract between their employer and ClearWay Minnesota.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request.

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