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A comprehensive economic assessment of the health effects of tobacco use and implications for tobacco control in Bangladesh
  1. Nigar Nargis1,
  2. Golam Mohiuddin Faruque2,
  3. Maruf Ahmed3,
  4. Iftekharul Huq4,
  5. Rehana Parven5,
  6. Syed Naimul Wadood6,
  7. AKM Ghulam Hussain6,
  8. Jeffrey Drope7
  1. 1Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
  2. 2Bangladesh Cancer Society, Dhaka, Bangladesh
  3. 3Bangladesh Institute of Development Studies, Dhaka, Bangladesh
  4. 4Department of Economics, East West University, Dhaka, Bangladesh
  5. 5Ministry of Finance of the Government of the People's Republic of Bangladesh, Dhaka, Bangladesh
  6. 6Department of Economics, University of Dhaka, Dhaka, Bangladesh
  7. 7School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Nigar Nargis, Economic and Health Policy Research, American Cancer Society, Atlanta GA 20004, USA; nigar.nargis{at}


Background Despite modest progress in reducing tobacco use, tobacco remains one of the major risk factors for non-communicable diseases in Bangladesh.

Methods Using disease-specific, prevalence-based, cost-of-illness approach, this research estimated the economic costs of tobacco use and exposure to secondhand smoke based on data collected from a nationally representative survey of 10 119 households in 2018.

Results The study estimated that 1.5 million adults were suffering from tobacco-attributable diseases and 61 000 children were suffering from diseases due to exposure to secondhand smoke in Bangladesh in 2018. Tobacco use caused 125 718 deaths in that year, accounting for 13.5% of all-cause deaths. The total economic cost was 305.6 billion Bangladeshi taka (BDT) (equivalent to 1.4% of gross domestic product or US$3.61 billion), including direct costs (private and public health expenditures) of BDT83.9 billion and indirect costs (productivity loss due to morbidity and premature mortality) of BDT221.7 billion. The total economic cost of tobacco more than doubled since 2004.

Conclusion Tobacco use imposes a significant and increasing disease and financial burden on society. The enormous tobacco-attributable healthcare costs and productivity loss underscore the need to strengthen the implementation of tobacco control policies to curb the epidemic.

  • smoking caused disease
  • economics
  • global health
  • low/middle income country
  • prevention

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  • Contributors NN designed the study and led the writing of the manuscript. GMF served as the subject matter expert in disease burden and cancer epidemiology. MA and IH undertook the data analysis and contributed to the preparation of the manuscript. RP, SNW and JD contributed to the writing of the manuscript. AKMGH supervised the survey design and implementation and contributed to data analysis and writing of the manuscript. All authors contributed to the revision of the manuscript.

  • Funding The research was funded by the Programme for Research, Advocacy and Capacity Building on Tobacco Taxation (PROACTT), a collaboration between Cancer Research UK and American Cancer Society, USA.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical clearance was obtained from the National Research Ethics Committee following the ethical guidelines of Bangladesh Medical Research Council (BMRC).

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

  • Data availability statement Deidentified data are available upon request from the Bangladesh Cancer Society 3 years after the collection of data when the embargo on data sharing is lifted.