German EstSmoke:Estimating adult smoking-related costs and consequences of smoking cessation for Germany

AIMS: We compared predicted lifetime health care costs for current, never and ex-smokers in Germany under the current set of tobacco control polices. We compared these economic consequences of the current situation with an alternative in which Germany were to implement more comprehensive tobacco control policies consistent with the WHO Framework Convention for Tobacco Control (FCTC) guidelines. DESIGN: German EstSmoke, an adapted version of the UK EstSmoke simulation model, applies the Markov modelling approach. Transition probabilities for (re-)currence of smoking-related disease were calculated from large German disease-specific registries and the German Health Update (GEDA 2010). Estimations of both health care costs and effect sizes of smoking cessation policies were taken from recent German studies and discounted at 3.5%/year. SETTING: Germany PARTICIPANTS: German population of prevalent current, never and ex-smokers in 2009: 81 million MEASUREMENT: Lifetime cost and outcomes in current, never and ex-smokers FINDINGS: If tobacco control policies are not strengthened, the German smoking population will incur €41.56 billion lifetime excess costs compared with never smokers. Implementing tobacco control policies consistent with WHO FCTC guidelines would reduce the difference of lifetime costs between current smokers and ex-smokers by at least €1.7 billion. CONCLUSIONS: Modelling suggests that the lifetime healthcare costs of people in Germany who smoke are substantially greater than those of people who have never smoked. However, more comprehensive tobacco control policies could reduce healthcare expenditure for current smokers by at least 4%.