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Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study
  1. Andrés Pichon-Riviere1,2,
  2. Ariel Bardach1,2,
  3. Federico Rodríguez Cairoli1,
  4. Agustín Casarini1,
  5. Natalia Espinola1,
  6. Lucas Perelli1,
  7. Luz Myriam Reynales-Shigematsu3,
  8. Blanca Llorente4,
  9. Marcia Pinto5,
  10. Belén Saenz De Miera Juárez6,
  11. Tatiana Villacres7,
  12. Esperanza Peña Torres8,
  13. Nydia Amador9,
  14. César Loza10,
  15. Marianela Castillo-Riquelme11,
  16. Javier Roberti2,
  17. Federico Augustovski1,
  18. Andrea Alcaraz1,
  19. Alfredo Palacios1
  1. 1Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
  2. 2CIESP, CONICET, Buenos Aires, Argentina
  3. 3Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
  4. 4Research Department, Fundación Anáas, Bogota, Colombia
  5. 5Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
  6. 6Department of Economics, Autonomous University of Baja California Sur, La Paz, Baja California Sur, Mexico
  7. 7Health Economics, Pontificia Universidad Católica del Ecuador, Quito, Pichincha, Ecuador
  8. 8Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
  9. 9Costa Rica Saludable, San José, Costa Rica
  10. 10Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
  11. 11Faculty of Medicine, Universidad de Chile Escuela de Salud Publica, Santiago, Chile
  1. Correspondence to Dr Andrés Pichon-Riviere, IECS, Ravignani 2024, (C1414CPV), Buenos Aires, Argentina; apichon{at}


Objective To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population.

Design Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers’ burden and interventions’ effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model.

Findings In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries’ aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures.

Conclusions Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits.

  • Public policy
  • Low/Middle income country
  • Advertising and Promotion
  • Taxation
  • Packaging and Labelling

Data availability statement

Data are available upon reasonable request.

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  • Twitter @APichonRiviere, @Cesar Loza@CsarLoza12, @AlfrePalacios13

  • Contributors Conceptualisation—AP-R, AB, FA, AA. Data curation, AP-R, AB, FC, AP, LMR-S, BL, MP, BSDMJ, TV, EPT, NA, CL, MC-R. Formal analysis—AP-R, AB, AA, FC, AC, LP, FA, AP, LMR-S, BL, MP, BSDMJ, TV, EPT, NA, CL, MC-R. Funding acquisition—AP-R, AB, AA. Investigation—AP-R, AB, AC, LP, FA, AA, AP, LMR-S. Methodology—AP-R, AB, AC, AP. Project administration—AP-R, AB, AA. Software—AP-R, AC. Supervision—AP-R, AB, AP, JR, AA. Validation—AP, AA, FA, LMR-S, MP, BSDMJ, TV, EPT, NA, CL, MC-R. Visualisation—AP-R, JR. Writing—AP-R, AA, AB, FC, AP. Original draft and writing—AP-R, AA, AB, AP. Review and editing of manuscript—all authors. AP-R is the guarantor for overall content.

  • Funding International Development Research Centre (IDRC), Canada.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.