title: Simulation of quitting smoking in the military shows higher lifetime medical spending more than offset by productivity gains.
abstract: Despite the documented benefits of quitting smoking, studies have found that smokers who quit may have higher lifetime medical costs, in part because of increased risk for medical conditions, such as type 2 diabetes, brought on by associated weight gain. Using a simulation model and data on 612,332 adult smokers in the US Department of Defense's TRICARE Prime health plan in 2008, we estimated that cessation accompanied by weight gain would increase average life expectancy by 3.7 years, and that the average lifetime reduction in medical expenditures from improved health ($5,600) would be offset by additional expenditures resulting from prolonged life ($7,300). Results varied by age and sex: For females ages 18-44 at time of cessation, there would be net savings of $1,200 despite additional medical expenditures from prolonged life. Avoidance of weight gain after quitting smoking would increase average life expectancy by four additional months and reduce mean extra spending resulting from prolonged life by $700. Overall, the average net lifetime health care cost increase of $1,700 or less per ex-smoker would be modest and, for employed people, more than offset by even one year's worth of productivity gains. These results boost the case for smoking cessation programs in the military in particular, along with not selling cigarettes in commissaries or at reduced prices.
authors.affiliation: Lewin Group, Falls Church, Virginia, USA. grace.yang@lewin.com
authors.forename: Wenya
authors.initials: W
authors.lastname: Yang
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Dall
authors.forename: Yiduo
authors.initials: Y
authors.lastname: Zhang
authors.forename: Shiping
authors.initials: S
authors.lastname: Zhang
authors.forename: David R
authors.initials: DR
authors.lastname: Arday
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Dorn
authors.forename: Anjali
authors.initials: A
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008889:Military Personnel; D009765:Obesity / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult