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CMAJ. 2010 November 9; 182(16): 1761–1762.
PMCID: PMC2972332

Governments, pay for smoking cessation

Your recent editorial correctly argues that provincial governments should provide funding for smoking cessation as it is a highly cost-effective way to improve population health.1 Alas, the editorial then repeats a common error of confusing cost-effectiveness with cost-saving. There is, in fact, good evidence that while smoking cessation may reduce health care spending over the medium term, in the longer term (15 to 30 years) health care spending is actually increased.2

The explanation for this is perfectly simple: nonsmokers live longer and therefore incur expensive health care costs in old age. These additional costs exceed the lower expenditures of earlier years. Quite apart from increased health care spending there would be two additional negative effects on government finances if all smokers quit: Governments would lose the hefty revenues generated by tobacco taxes, and there would be increased spending on pension payments.

This argument appeared in an analysis carried out by the British government in 1971. The report was never officially published but was leaked in 1980.3,4

What applies to smoking also applies in other scenarios: the prevention of fatal diseases actually leads to an increase in health care spending.5 Indeed, our best evidence is that most medical interventions designed to prevent disease or improve health cause an increase in health care spending.6

Of course, the prevention of fatal diseases is undeniably of great value with regard to population health and should therefore be strongly supported. Moreover, prevention can often be much more cost-effective than many medical treatments.7 However, this is altogether different from decreasing health care spending.


1. Penz ED, Manns BJ, Hébert PC, et al. Governments, pay for smoking cessation. CMAJ. 2010 Aug 30; doi: 10.1503/cmaj.101140. [Epub ahead of print] [PMC free article] [PubMed] [Cross Ref]
2. Barendregt JJ, Bonneux L, van der Maas PJ. The health care costs of smoking. N Engl J Med. 1997;337:1052–7. [PubMed]
3. Phillips M. Why smoking not health wins the day. Guardian [London] 1980 May 6;
4. Leichter H. Voluntary health risks and public policy. 2. Public policy and the British experience. Hastings Cent Rep. 1981;11:32–9. [PubMed]
5. Bonneux L, Barendregt JJ, Nusselder WJ, et al. Preventing fatal diseases increases healthcare costs: cause elimination life table approach. BMJ. 1998;316:26–9. [PMC free article] [PubMed]
6. Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med. 2008;358:661–3. [PubMed]
7. Temple NJ. Disease prevention: the neglected alternative. In: Temple NJ, Thompson A, editors. Excessive medical spending: facing the challenge. Oxford (UK): Radcliffe Publishing; 2007. pp. 152–65.

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