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Quantifying the social costs and benefits of tobacco in Estonia
  1. Indrek Saar1,2,
  2. Helle Koitla1
  1. 1Financial College, Estonian Academy of Security Sciences, Tallinn, Harjumaa, Estonia
  2. 2School of Governance, Law and Society, Tallinn University, Tallinn, Harjumaa, Estonia
  1. Correspondence to Dr Indrek Saar, Financial College, Estonian Academy of Security Sciences, Tallinn 12012, Harjumaa, Estonia; indreksr{at}


Background The tobacco cost literature has predominantly focused on estimating direct healthcare costs and productivity losses from morbidity and mortality. This study places a greater focus on the effects that arise through the fiscal system, illicit trade and fire accidents to estimate the social costs and benefits of tobacco use in Estonia in 2018.

Methods A prevalence-based cost-of-illness approach was used, relying on data from the 2017–2018 period. Age-specific tobacco-attributable fractions were employed to estimate the costs and benefits of tobacco-related morbidity and mortality. Data on mortality, morbidity and healthcare costs were received from the National Institute of Health Development and the Estonian Health Insurance Fund. We used data for offences and fires from the Estonian Rescue Board and the Estonian Tax and Customs Board.

Results It was estimated that the total social cost attributable to tobacco in Estonia in 2018 was €174 million, representing 0.67% of the nation’s GDP. If future benefits are also considered, the net social cost is €78 million. While the greatest cost components are productivity losses from mortality and morbidity, the level of tobacco-related law enforcement costs are comparable to direct healthcare costs, both of which exceed €10 million annually.

Conclusions Despite the substantial social benefits arising through the fiscal system, tobacco-related costs outweighed these benefits in Estonia in 2018. In addition, a considerable portion of the economic burden of tobacco is associated with illicit trade. Therefore, the healthcare and law enforcement sectors would both benefit from effective tobacco control policies.

  • economics
  • illegal tobacco products
  • taxation

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  • Contributors IS contributed to the design and implementation of the research, analysis of the results and writing of the manuscript. HK contributed to the design and the implementation of the research.

  • Funding The study was supported by the Secretariat of the WHO Framework Convention on Tobacco Control.

  • Disclaimer The present paper was produced as part of the 'Pilot project on Illicit Trade in Tobacco Products in the European Union 2017–2019', implemented by the Secretariat of the WHO Framework Convention on Tobacco Control, with the financial assistance of the European Union. The opinions expressed in this document are those of the authors. They do not purport to reflect the opinions or views of the Secretariat of the WHO Framework Convention on Tobacco Control and the Protocol to Eliminate Illicit Trade in Tobacco Products.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request from the corresponding author.