title: Medical costs and quality-adjusted life years associated with smoking: a systematic review.
abstract: Estimated medical costs ("T") and QALYs ("Q") associated with smoking are frequently used in cost-utility analyses of tobacco control interventions. The goal of this study was to understand how researchers have addressed the methodological challenges involved in estimating these parameters.
  
  
  
  Data were collected as part of a systematic review of tobacco modeling studies. We searched five electronic databases on July 1, 2013 with no date restrictions and synthesized studies qualitatively. Studies were eligible for the current analysis if they were U.S.-based, provided an estimate for Q, and used a societal perspective and lifetime analytic horizon to estimate T. We identified common methods and frequently cited sources used to obtain these estimates.
  
  
  
  Across all 18 studies included in this review, 50 % cited a 1992 source to estimate the medical costs associated with smoking and 56 % cited a 1996 study to derive the estimate for QALYs saved by quitting or preventing smoking. Approaches for estimating T varied dramatically among the studies included in this review. T was valued as a positive number, negative number and $0; five studies did not include estimates for T in their analyses. The most commonly cited source for Q based its estimate on the Health Utilities Index (HUI). Several papers also cited sources that based their estimates for Q on the Quality of Well-Being Scale and the EuroQol five dimensions questionnaire (EQ-5D).
  
  
  
  Current estimates of the lifetime medical care costs and the QALYs associated with smoking are dated and do not reflect the latest evidence on the health effects of smoking, nor the current costs and benefits of smoking cessation and prevention. Given these limitations, we recommend that researchers conducting economic evaluations of tobacco control interventions perform extensive sensitivity analyses around these parameter estimates.
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC, 20001, USA.
authors.forename: Shari P
authors.initials: SP
authors.lastname: Feirman
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC, 20001, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Glasser
authors.affiliation: Evaluation Science and Research, Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC, 20001, USA.|Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, 21218, USA.
authors.forename: Lyubov
authors.initials: L
authors.lastname: Teplitskaya
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Holtgrave
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC, 20001, USA.|Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.|Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3970 Reservoir Road NW E501, Washington, DC, 20007, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Abrams
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC, 20001, USA.|Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.|Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3970 Reservoir Road NW E501, Washington, DC, 20007, USA.
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Niaura
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC, 20001, USA. avillanti@truthinitiative.org.|Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. avillanti@truthinitiative.org.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Villanti
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000191:economics*; D016540:Smoking Cessation / Q000191:economics; D062789:Tobacco Products / Q000191:economics; D055815:Young Adult
keywords: Medical costs; QALY; Smoking