A comprehensive economic assessment of the health effects of tobacco use and implications for tobacco control in Bangladesh

Introduction
Tobacco is one of the greatest risk factors for noncommunicable diseases (NCDs) including cancers and cardiovascular and respiratory diseases. Globally smoking, chewing tobacco, and exposure to secondhand smoke together were responsible for the loss of 8.7 million lives and 230 million disability-adjusted life years in 2019. The global economic cost of smoking-attributable diseases from health expenditures and productivity losses was estimated at US$1436 billion in 2012, roughly equivalent to 1.8% of the world’s annual gross domestic product (GDP). Globally there are 1.1 billion tobacco smokers 15 and older, around 80% of whom live in low-income and middle-income countries (LMICs). Among LMICs, Bangladesh is one of the highest tobacco-burdened countries. The prevalence of tobacco use among adults 15 and older was 35.3% in 2017.
There was, however, some progress in reducing tobacco use in the recent past from 43.3% in 2009. The economic cost associated with the deaths and disease burden of tobacco use has been assessed in numerous country-specific studies, mostly in high-income countries. Although an earlier study assessed the cost of tobacco-related illnesses in Bangladesh in 2004, no recent estimate is available to measure the progress in avoiding tobacco attributable costs on society.
The primary objective of the present study was to update the estimates of the direct and indirect health costs attributable to tobacco use and exposure to secondhand smoke and compare with the previous estimates available for 2004. By maintaining the cost-of-illness approach followed in the 2004 study, this study provides a consistent comparison of the economic costs of tobacco over time.

Background: Despite modest progress in reducing tobacco use, tobacco remains one of the major risk factors for non-communicable diseases in Bangladesh.

Methods: Using a disease-specific, prevalence-based, cost-of-illness approach, this research estimated the economic costs of tobacco use and exposure to secondhand smoke based on data collected from a nationally representative survey of 10 119 households in 2018.

Results: The study estimated that 1.5 million adults were suffering from tobacco-attributable diseases and 61 000 children were suffering from diseases due to exposure to secondhand smoke in Bangladesh in 2018. Tobacco use caused 125 718 deaths in that year, accounting for 13.5% of all-cause deaths. The total economic cost was 305.6 billion Bangladeshi taka (BDT) (equivalent to 1.4% of gross domestic product or US$3.61 billion), including direct costs (private and public health expenditures) of BDT83.9 billion and indirect costs (productivity loss due to morbidity and premature mortality) of BDT221.7 billion. The total economic cost of tobacco more than doubled since 2004.

Conclusion: Tobacco use imposes a significant and increasing disease and financial burden on society. The enormous tobacco-attributable healthcare costs and productivity loss underscore the need to strengthen the implementation of tobacco control policies to curb the epidemic.

 

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Nigar Nargis, Golam Mohiuddin Faruque, Maruf Ahmed, Iftekharul Huq, Rehana Parven, Syed Naimul Wadood, AKM Ghulam Hussain and Jeffrey Drope