MANAGED CARE March 2004. ©MediMedia USA
The recent 40th anniversary of the surgeon general's report on smoking brought some staggering statistics to the public's attention. The New England Journal of Medicine reports that "In 2001, the prevalence of smoking in the United States stood at 25.5 percent among men and 21.5 percent among women, down from the peaks of 57 percent among men in 1955 and 34 percent among women in 1965. Rates of smoking have plateaued, however, since 1990.... Smoking rates are declining among all age groups, except among persons 18 to 24 years of age, among whom the prevalence rose from 23 percent in 1991 to 27 percent in 2000."
Figuring out how much money the health system may have saved as a result of the campaign against smoking is a "very complicated story," says Ken Warner, PhD, the director of the tobacco research network at the University of Michigan.
"You may have heard the argument made by the tobacco industry's experts in the trials, which is true, that if people don't smoke, they live longer. If they live longer, they're prone to get old age diseases," says Warner. "While that is true, it is also true that at a given age, survivors of smoking will tend to cost more than people who never smoked. So even if you're 80 years old, when you're a smoker, you're going to cost more."
After years of being in the thick of this debate, Warner, an economist, cautiously opines that smoking does indeed save the health care system money. However, he challenges the question. "Nobody ever asks how much money do we save by treating breast cancer," says Warner. "In fact, if we went on the basis of asking how much money do we save by doing x, y, z — this may sound facetious, but it's true — far and away the least expensive health care system would be to outlaw health care." Warner insists that the relevant question is: "What is cost-effective?" Smoking cessation is the gold standard in cost-effectiveness. "There's very little that the health care system can do to improve the health of their patients at a reasonable cost that compares with smoking cessation."