title: Prevalence-based, disease-specific estimate of the social cost of smoking in Singapore.
abstract: To estimate the cost of smoking in Singapore in 2014 from the societal perspective.
  
  
  
  A prevalence-based, disease-specific approach was undertaken to estimate the smoking-attributable costs. These include direct and indirect costs of inpatient treatment, premature mortality, loss of productivity due to medical leaves and smoking breaks.
  
  
  
  In 2014, the social cost of smoking in Singapore was conservatively estimated to be at least US$479.8 million, ∼0.2% of the 2014 gross domestic product. Most of this cost was attributable to productivity losses (US$464.9 million) and largely concentrated in the male population (US$434.9 million). Direct healthcare costs amounted to US$14.9 million where ischaemic heart disease and lung cancer had the highest cost burden.
  
  
  
  The social cost of smoking is smaller in Singapore than in other Asian countries. However, there is still cause for concern. A recently observed increase in smoking prevalence, particularly among adolescent men, is likely to result in rising total cost. Most significantly, our results suggest that a large share of the overall cost burden lies outside the healthcare system or may not be highly salient to the relevant decision makers. This is partly because of the nature of such costs (indirect or intangible costs such as productivity losses are often not salient) or data limitations (a potentially significant fraction of direct healthcare expenditure may be in private primary care where costs are not systematically captured and reported). The case of Singapore thus illustrates that even in countries perceived as success stories, strong multisectoral anti-tobacco strategies and a supporting research agenda continue to be needed.
authors.affiliation: Saw Swee Hock School of Public Health-National University of Singapore, Singapore, Singapore.
authors.forename: Boon Piang
authors.identifier: 0000-0001-5745-8133
authors.initials: BP
authors.lastname: Cher
authors.affiliation: Saw Swee Hock School of Public Health-National University of Singapore, Singapore, Singapore.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chen
authors.affiliation: Saw Swee Hock School of Public Health-National University of Singapore, Singapore, Singapore.
authors.forename: Joanne
authors.initials: J
authors.lastname: Yoong
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004180:Direct Service Costs; D004526:Efficiency; D005260:Female; D059066:Gross Domestic Product; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D017202:Myocardial Ischemia / Q000191:economics* / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000209:etiology; D018582:Sick Leave / Q000191:economics; D012846:Singapore / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000191:economics / Q000453:epidemiology*; D020521:Stroke / Q000191:economics* / Q000209:etiology; D000073869:Tobacco Smoking / Q000009:adverse effects / Q000191:economics*; D055815:Young Adult
keywords: PUBLIC HEALTH; Tobacco and smoking