title: Health care expenditures attributable to smoking in military veterans.
abstract: BACKGROUND
  The health effects of cigarette smoking have been estimated to account for between 6%-8% of U.S. health care expenditures. We estimated Veterans Health Administration (VHA) health care costs attributable to cigarette smoking.
  
  
  METHODS
  VHA survey and administrative data provided the number of Veteran enrollees, current and former smoking prevalence, and the cost of 4 types of care for groups defined by age, gender, and region. Cost and smoking status could not be linked at the enrollee level, so we used smoking attributable fractions estimated in sample of U.S. residents where the linkage could be made.
  
  
  RESULTS
  The 7.7 million Veterans enrolled in VHA received $40.2 billion in VHA provided health services in 2010. We estimated that $2.7 billion in VHA costs were attributable to the health effects of smoking. This was 7.6% of the $35.3 billion spent on the types of care for which smoking-attributable fractions could be determined. The fraction of inpatient costs that was attributable to smoking (11.4%) was greater than the fraction of ambulatory care cost attributable to smoking (5.3%). More cost was attributable to current smokers ($1.7 billion) than to former smokers ($983 million).
  
  
  CONCLUSIONS
  The fraction of VHA costs attributable to smoking is similar to that of other health care systems. Smoking among Veterans is slowly decreasing, but prevalence remains high in Veterans with psychiatric and substance use disorders, and in younger and female Veterans. VHA has adopted a number of smoking cessation programs that have the potential for reducing future smoking-attributable costs.
authors.affiliation: Health Economics Resource Center, U.S. Department of Veterans Affairs, Menlo Park, CA; Treatment Research Center, University of California, San Francisco, CA; paul.barnett@va.gov.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Barnett
authors.affiliation: Public Health Strategic Health Care Group, U.S. Department of Veterans Affairs, Washington, DC;
authors.forename: Kim
authors.initials: K
authors.lastname: Hamlett-Berry
authors.affiliation: Institute for Health and Aging, University of California, San Francisco, CA.
authors.forename: Hai-Yen
authors.initials: HY
authors.lastname: Sung
authors.affiliation: Institute for Health and Aging, University of California, San Francisco, CA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Max
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D015995:Prevalence; D012907:Smoking / Q000191:economics* / Q000453:epidemiology; D016540:Smoking Cessation / Q000706:statistics & numerical data; D014029:Tobacco Use Disorder / Q000191:economics* / Q000453:epidemiology; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D058014:Veterans Health; D055815:Young Adult