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A dynamic model of smoking and healthcare expenditures in CA

Institution: University of California, San Francisco
Investigator(s): Wendy Max, Ph.D.
Award Cycle: 2000 (Cycle 9) Grant #: 9RT-0157 Award: $595,843
Subject Area: Public Health, Public Policy, and Economics
Award Type: Research Project Awards
Abstracts

Initial Award Abstract
This study will develop a series of related models that permit us to understand the impact of smoking on healthcare costs through several different pathways. The impact of smoking on health changes with the intensity of smoking (packs per day), with the length of time one smokes, with the age one is if and when they quit, and as one ages. The models will analyze the impact of smoking on health status, on the likelihood of having a smoking-caused disease, and the impact of poor health and disease on healthcare expenditures. The models will be developed using national surveys, and will be applied to California to estimate the annual and lifetime healthcare expenditures that can be attributed to smoking in California. The models will then be used to address a question of great policy relevance in California: what has been net effect of the California Tobacco Control program on healthcare costs? The study has six specific aims.

Aim 1. Develop a model that analyzes the effect of smoking on health status, the effect of health status on medical expenditures, and the impact of smoking cessation on the combined effects. Aim 2. Develop a model that analyzes the effect of smoking on the likelihood of having a smoking-caused disease (such as lung cancer), the effect of having a smoking-caused disease on medical expenditures, and the impact of quitting smoking on the combined effects. Aim 3. Develop a model of smoking caused deaths. Smokers are known to be at greater risk of death from a number of diseases. This model will consider the effect of smoking on the probability of death, and will analyze the reduced deaths resulting from quitting smoking. Aim 4. Develop a model of nursing home costs. Smoking impacts nursing home costs in several ways. This model will consider the increased likelihood of being in a nursing home caused by smoking-related diseases as well as due to the death of a spouse caused by his/her smoking. Aim 5. The models will be combined and applied to the state of California, using California-specific data on smoking history, its population characteristics, their risk behaviors, and healthcare expenditures. Both the annual smoking-related medical expenditures and lifetime medical expenditures resulting from smoking in California will be estimated. Aim 6. Analyze the economic impact of the California Tobacco Control Program using the models developed here. We will analyze the impact of the program on smoking prevalence and the impact of changed prevalence on healthcare expenditures in the state. The first ten years of the program will be analyzed, and we will predict the impact during the next 25 years.
Publications

The financial impact of smoking on health-related costs: a review of the literature
Periodical: California Department of Health Services Publication Index Medicus:
Authors: Max W ART
Yr: 2002 Vol: Nbr: Abs: Pg:

Impact of smoking habit on medical care use and its costs.
Periodical: International Journal of Epidemiology Index Medicus:
Authors: Rice DP ART
Yr: 2001 Vol: 20 Nbr: Abs: Pg: 622-623

The cost of smoking in California, 1999.
Periodical: California Department of Health Services Publication Index Medicus:
Authors: Max W, Rice DP, Zhang X, Sung H-Y, Miller L ART
Yr: 2002 Vol: Nbr: Abs: Pg:

The benefits of switching smoking cessation drugs to over-the counter status.
Periodical: Health Economics Index Medicus:
Authors: Keeler T, Hu T-W, Keith A, Manning R, Marciniak M, Ong M, Sung H-Y ART
Yr: 2002 Vol: 11 Nbr: 5 Abs: Pg: 389-402

The behaviour of purchasing smuggled cigarettes in Taiwan.
Periodical: Tobacco Control Index Medicus:
Authors: Tsai Y-W, Sung H-Y, Yang C-L, Shih S-F ABS
Yr: 2003 Vol: 12 Nbr: 1 Abs: Pg: 28-33