摘要：Objectives. We estimated the economic impact of reductions in the prevalence of tobacco smoking on health, production, and leisure in the 2008 Australian population. Methods. We selected a prevalence target of 15%. Cohort lifetime health benefits were modeled as fewer incident cases of tobacco-related diseases, deaths, and disability-adjusted life-years. We estimated production gains by comparing surveyed participation and absenteeism rates of adult smokers and ex-smokers valued according to the human capital and friction cost approaches. We estimated household production and leisure gains from time use surveys and valued these gains with the appropriate proxy. Results. In the 2008 Australian population, an absolute reduction in smoking prevalence of 8% would result in 158 000 fewer incident cases of disease, 5000 fewer deaths, 2.2 million fewer lost working days, and 3000 fewer early retirements and would reduce health sector costs by AUD 491 million. The gain in workforce production was AUD 415 million (friction cost) or AUD 863 million (human capital), along with gains of 373 000 days of household production and 23 000 days of leisure time. Conclusions. Lowering smoking prevalence rates can lead to substantial economic savings and health benefits. The deleterious impact of tobacco smoking on health is well understood, 1 and the health benefits of reducing the proportion of a country's citizens who smoke tobacco have been quantified numerous times. 2 , 3 For example, in the most recent Australian Burden of Disease Study, conducted in 2003, tobacco use was responsible for the greatest disease burden (7.8%) in the country among the 14 risk factors reviewed. 4 In recent years, with comprehensive tobacco control programs, Australian tobacco smoking prevalence rates have decreased by about 1 percentage point per year. 5 Australian tobacco control programs include media education campaigns, legislation (bans on smoking in public places, graphic warnings on packaging, point-of-sale advertising bans), and heavy tobacco product taxation. Although smoking-related cancers have declined after several decades of successful tobacco control efforts, 6 further efforts to expand the range of effective prevention strategies are needed and should be similarly beneficial. In 2004 and 2005, 23% of adults (aged 18 years or older) in Australia were current tobacco smokers, with 21% smoking daily and 2% less than daily; 30% were ex-smokers; and 47% had never smoked. 7 Quantifying the importance of investing in further prevention initiatives is crucial given that only 3% of Australian health expenditures are devoted to prevention and health promotion. 8 , 9 Such efforts are timely in that they provide added impetus to the important work of the National Preventative Health Taskforce (which is focused on tobacco, obesity, and alcohol use) 10 and lend support to the comprehensive strategies and work plans of important Australian health promotion organizations with tobacco control objectives (the Victorian Health Promotion Foundation and Quit). There is limited information about the potential impact of reducing the prevalence of tobacco smoking as opposed to attempting to completely eliminate it. The consequent impact of improved health on paid and unpaid production and on leisure time have similarly not been estimated for a scenario of realistic reduced smoking prevalence levels. We estimated the economic impact of reductions in the prevalence of tobacco smoking on health, production, and leisure in the 2008 Australian adult population. This study was part of a project funded by the Victorian Health Promotion Foundation, completed in 2009, that sought to evaluate the health, economic, and financial benefits of reductions in the prevalence of 6 important risk factors (alcohol use, physical inactivity, high body mass index, tobacco smoking, inadequate consumption of fruit and vegetables, and intimate partner violence). The project is described in greater detail elsewhere 11 (details are also available at http://vichealth.vic.gov.au/Resource-Centre/Publications-and-Resources/Research/Health-and-economic-benefits-of-reducing-disease-risk-factors.aspx ).
