Building a House on Sand: How Tobacco Use Is Devouring Resources

Document Type : Review Article(s)


1 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

2 Ministry of Health and Medical Education, National Center for Strategic Research in Medical Education, Tehran, Iran



Background: Tobacco is a major cause of preventable morbidity and mortality, with a considerable economic burden. The purpose 
of this systematic review was to summarize the evidence on the economic burden of tobacco use by searching national and 
international databases so as to generate useful information about the costs of tobacco use globally.

Methods: A systematic search was conducted in Scopus, PubMed, EMBASE, ProQuest, and Web of Science (ISI) databases to 
identify relevant studies from 1990 to June 2021 using keywords like burden, productivity, indirect cost, direct cost, economic, 
monetary, expenditure, tobacco, smoking, and cigarettes. Cost estimates were converted into 2020 international dollars per adult.

Findings: A total of 1,781 articles were identified, of which 361 were deemed to be eligible for inclusion. Eventually, 23 articles 
were found eligible. In most studies, cost estimates were provided using a prevalence-based approach. The highest total cost, as 
a percentage of gross domestic product (GDP), was reported for South Korea (1.19%). Noteworthy, in all studies, indirect costs 
accounted for the highest proportion of all costs. The mean total cost amounted to 5,866 million dollars. The direct costs ranged 
from 179 million dollars in South Korea to 8,156 million dollars in Israel. Meanwhile, the indirect costs ranged from 289 million 
dollars in Hong Kong to 9,808 million dollars in India. 

Conclusion: The evidence demonstrated the considerable economic burden of tobacco use in various countries, ranging from 0.33 
to 1.19% of the GDP of the investigated countries, indicating the necessity of taking immediate measures. Hence, policies are 
needed to address the economic burden of smoking.


Mohammad Bakhtiari Aliabad: (Google Scholar) (PubMed)

Iravan Masoudi-Asl: (Google Scholar) (PubMed)

Masoud Abolhallaje: (Google Scholar) (PubMed)

Mehdi Jafari: (Google Scholar) (PubMed)


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