title: [Financial impact of smoking on health systems in Latin America: A study of seven countries and extrapolation to the regional level].
abstract: OBJECTIVE
  Estimate smoking-attributable direct medical costs in Latin American health systems.
  
  
  METHODS
  A microsimulation model was used to quantify financial impact of cardiovascular and cerebrovascular disease, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and nine other neoplasms. A systematic search for epidemiological data and event costs was carried out. The model was calibrated and validated for Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, countries that account for 78% of Latin America's population; the results were then extrapolated to the regional level.
  
  
  RESULTS
  Every year, smoking is responsible for 33 576 billion dollars in direct costs to health systems. This amounts to 0.7% of the region's gross domestic product (GDP) and 8.3% of its health budget. Cardiovascular disease, COPD, and cancer were responsible for 30.3%, 26.9%, and 23.7% of these expenditures, respectively. Smoking-attributable costs ranged from 0.4% (Mexico and Peru) to 0.9% (Chile) of GDP and from 5.2% (Brazil) to 12.7% (Bolivia) of health expenditures. In the region, tax revenues from cigarette sales barely cover 37% of smoking-attributable health expenditures (8.1% in Bolivia and 67.3% in Argentina).
  
  
  CONCLUSIONS
  Smoking is responsible for a significant proportion of health spending in Latin America, and tax revenues from cigarette sales are far from covering it. The region's countries should seriously consider stronger measures, such as an increase in tobacco taxes.
authors.affiliation: Instituto de Efectividad Clínica y Sanitaria (IECS - CONICET), Argentina.
authors.forename: Andrés
authors.initials: A
authors.lastname: Pichon-Riviere
authors.affiliation: Instituto de Efectividad Clínica y Sanitaria (IECS - CONICET), Argentina.
authors.forename: Ariel
authors.initials: A
authors.lastname: Bardach
authors.affiliation: Instituto de Efectividad Clínica y Sanitaria (IECS - CONICET), Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Augustovski
authors.affiliation: Instituto de Efectividad Clínica y Sanitaria (IECS - CONICET), Argentina.
authors.forename: Andrea
authors.initials: A
authors.lastname: Alcaraz
authors.affiliation: Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), México.
authors.forename: Luz Myriam
authors.initials: LM
authors.lastname: Reynales-Shigematsu
authors.affiliation: Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Márcia Teixeira
authors.initials: MT
authors.lastname: Pinto
authors.affiliation: Departamento de Economía de la Salud, Ministerio de Salud, Chile.
authors.forename: Marianela
authors.initials: M
authors.lastname: Castillo-Riquelme
authors.affiliation: Instituto de Evaluación Tecnológica en Salud (IETS), Colombia.
authors.forename: Esperanza Peña
authors.initials: EP
authors.lastname: Torres
authors.affiliation: Instituto de Evaluación Tecnológica en Salud (IETS), Colombia.
authors.forename: Diana Isabel
authors.initials: DI
authors.lastname: Osorio
authors.affiliation: Universidad Peruana Cayetano Heredia, Perú.
authors.forename: Leandro
authors.initials: L
authors.lastname: Huayanay
authors.affiliation: Universidad Peruana Cayetano Heredia, Perú.
authors.forename: César Loza
authors.initials: CL
authors.lastname: Munarriz
authors.affiliation: Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), México.
authors.forename: Belén Sáenz
authors.initials: BS
authors.lastname: de Miera-Juárez
authors.affiliation: Centro Nacional de Excelencia Tecnológica en Salud (CENETEC), Secretaría de Salud, México.
authors.forename: Verónica
authors.initials: V
authors.lastname: Gallegos-Rivero
authors.affiliation: Capacitación, Investigación y Gestión para la Salud Basada en la Evidencia (CIGES), Universidad de la Frontera, Chile.
authors.forename: Catherine De La
authors.initials: C
authors.lastname: Puente
authors.affiliation: Universidad Mayor de San Andrés, Bolivia.
authors.forename: María Del Pilar
authors.initials: MD
authors.lastname: Navia-Bueno
authors.affiliation: Instituto de Efectividad Clínica y Sanitaria (IECS - CONICET), Argentina.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Caporale
mesh_terms: D001118:Argentina; D001838:Bolivia; D001938:Brazil; D002677:Chile; D003105:Colombia; D005102:Health Expenditures; D006801:Humans; D007843:Latin America; D008800:Mexico; D009313:National Health Programs / Q000191:economics*; D010568:Peru; D012907:Smoking / Q000191:economics*