Costs of employee smoking in the workplace in Scotland

BACKGROUND: Employers have responded to new regulations on the effects of passive smoking by introducing a range of workplace policies. Few policies include provision of smoking cessation intervention. OBJECTIVE: To estimate the cost to employers of smoking in the workplace in Scotland to illustrate the potential gains from smoking cessation provision. Costs vary with type of smoking policy in place; therefore, to estimate these costs results from a survey were combined with evidence drawn from a literature review. STUDY DESIGN: A telephone survey of 200 Scottish workplaces, based on a stratified random sample of workplaces with 50 or more employees, was conducted in 1996. Additional evidence was compiled from a review of the literature of smoking related costs and specific smoking related effects. RESULTS: 167 completed responses were received, of which 156 employers (93%) operated a smoking policy, 57 (34%) operated smoke free buildings, and 89 (53%) restricted smoking to a "smoke room". The research literature shows absenteeism to be higher among smokers when compared to non-smokers. The estimated cost of smoking related absence in Scotland is pound40 million per annum. Total productivity losses are estimated at approximately pound450 million per annum. In addition, the resource cost in terms of losses from fires caused by smoking materials is estimated at approximately pound4 million per annum. In addition, there are costs from smoking related deaths and smoking related damage to premises. CONCLUSION: This study shows how smoking cessation interventions in the workplace can yield positive cost savings for employers, resulting in gains in productivity and workplace attendance which may outweigh the cost of any smoking cessation programme.     

Environmental costs of freshwater eutrophication in England and Wales

Eutrophication has many known consequences, but there are few data on the environmental and health costs. We developed a new framework of cost categories that assess both social and ecological damage costs and policy response costs. These findings indicate the severe effects of nutrient enrichment and eutrophication on many sectors of the economy. We estimate the damage costs of freshwater eutrophication in England and Wales to be $105-160 million yr(-1) (pound 75.0-114.3 m). The policy response costs are a measure of how much is being spent to address this damage, and these amount to $77 million yr(-1) pound 54.8 m). The damage costs are dominated by seven items each with costs of $15 million yr(-1) or more: reduced value of waterfront dwellings, drinking water treatment costs for nitrogen removal, reduced recreational and amenity value of water bodies, drinking water treatment costs for removal of algal toxins and decomposition products, reduced value of nonpolluted atmosphere, negative ecological effects on biota, and net economic losses from the tourist industry. In common with other environmental problems, it would represent net value (or cost reduction) if damage was prevented at source. A variety of effective economic, regulatory, and administrative policy instruments are available for internalizing these costs.     

Short term effects of cigarette smoking on hospitalisation and associated lost workdays in a young healthy population

OBJECTIVE: There are relatively few published studies conducted among people of younger ages examining short term outcomes of cigarette smoking, and only a small number with outcomes important to employers. The present study was designed to assess the short term effects of smoking on hospitalisation and lost workdays. DESIGN: Retrospective cohort study. SETTING: Military population. SUBJECTS: 87 991 men and women serving on active duty in the US Army during 1987 to 1998 who took a health risk appraisal two or more times and were followed for an average of 2.4 years. MAIN OUTCOME MEASURES: Rate ratios for hospitalisations and lost workdays, and fraction of hospitalisations and lost workdays attributable to current smoking (population attributable fraction). RESULTS: Compared with never smokers, men and women who were current smokers had higher short term rates of hospitalisation and lost workdays for a broad range of conditions. Population attributable fractions (PAFs) for outcomes not related to injury or pregnancy were 7.5% (men) and 5.0% (women) for hospitalisation, and 14.1% (men) and 3.0% (women) for lost workdays. Evidence suggests that current smoking may have been under reported in this cohort, in which case the true PAFs would be higher than those reported. CONCLUSIONS: In this young healthy population, substantial fractions of hospitalisations and lost workdays were attributable to current smoking, particularly among men.     

The economic impact of poultry-borne salmonellosis: how much should be spent on prophylaxis?

Foodborne salmonellosis constitutes a major health problem in many countries. Moreover, the costs associated with salmonellosis could be considerable. There are thus strong arguments for preventive efforts. Ambitious, often government-sponsored, programmes aimed at preventing and controlling salmonellosis in for instance, poultry production represent one alternative to lower salmonellosis-related illness and economic costs. On the other hand, such comprehensive programmes are rather resource-demanding. From the economic point of view the key problem is to find the optimal level for prophylactic measures. The purpose of this study is to compare two different approaches to preventing poultry-borne salmonellosis among humans. We identify and compare the economic costs of illness due to poultry-borne salmonellosis and the costs of salmonella control in England and Wales and Sweden, respectively. An alternative option is then introduced: the concept of competitive exclusion (CE). Our results show that the cost of illness constitutes the major part of the total cost in England and Wales, whereas in Sweden, the control cost amounts to 95% of the total cost. By using the CE concept, the cost of illness due to poultry-borne salmonellosis in England and Wales could be reduced by at least GB pound 12.6 million. These advantages apply to individuals, producers, and to society, and we thus conclude that the CE concept is a very cost-effective way of using scarce resources.     

Cost of illness and disease burden in The Netherlands due to infections with Shiga toxin-producing Escherichia coli O157

Infections with Shiga toxin-producing Escherichia coli O157 (STEC O157) are associated with hemorrhagic colitis, hemolytic uremic syndrome (HUS), and end-stage renal disease (ESRD). In the present study, we extend previous estimates of the burden of disease associated with STEC O157 with estimates of the associated cost of illness in The Netherlands. A second-order stochastic simulation model was used to calculate disease burden as disability-adjusted life years (DALYs) and cost of illness (including direct health care costs and indirect non-health care costs). Future burden and costs are presented undiscounted and discounted at annual percentages of 1.5 and 4%, respectively. Annually, approximately 2.100 persons per year experience symptoms of gastroenteritis, leading to 22 cases of HUS and 3 cases of ESRD. The disease burden at the population level was estimated at 133 DALYs (87 DALYs discounted) per year. Total annual undiscounted and discounted costs of illness due to STEC O157 infection for the Dutch society were estimated at ?.1 million and ?.5 million, respectively. Average lifetime undiscounted and discounted costs per case were both ?26 for diarrheal illness, both ?5,713 for HUS, and ?.76 million and ?.22 million, respectively, for ESRD. The undiscounted and discounted costs per case of diarrheal disease including sequelae were ?,132 and ?,131, respectively. Compared with other foodborne pathogens, STEC O157 infections result in relatively low burden and low annual costs at the societal level, but the burden and costs per case are high.     

三联锅甑在酿酒生产中的应用

在酿酒生产中采用三联锅甑可充分利用人力和节约时间，吨酒节汽0．12t，全年可节约蒸汽成本10万元以上；设备耐腐性提高，可降低日常维护费用，延长设备使用寿命。（孙悟）     

A mass media programme to prevent smoking among adolescents: costs and cost effectiveness

OBJECTIVE: To examine costs and cost-effectiveness ratios of a four- year mass media programme previously shown to prevent the onset of smoking among adolescents. DESIGN: A matched control design. SETTING: Two cities in Montana, one in New York and one in Vermont, USA. SUBJECTS: Students in grades 10-12 (ages 15-18). INTERVENTION: A four- year mass media campaign to prevent the onset of smoking. MAIN OUTCOME MEASURES: Cost per student potentially exposed to the mass media campaign; cost per student smoker potentially averted; and cost per life-year gained. Cost estimates were also made for a similar campaign that would be broadcast nationally in the United States. RESULTS: In 1996 dollars, the cost of developing and broadcasting the mass media campaign was $759,436, and the cost per student potentially exposed to the campaign (n = 18,600) was $41. The cost per student smoker averted (n = 1023) was $754 (95% confidence interval (CI) = $531-$1296). The cost per life-year gained discounted at 3% over the life expectancy for young adult smokers was $696 (95% CI = $445-$1269). The estimated cost of developing and broadcasting a similar four-year mass media campaign in all 209 American media markets would be approximately $84.5 million, at a cost of $8 per student potentially exposed to a national campaign, $162 per student smoker averted, and $138 (95% CI = $88-$252) per life- year gained. CONCLUSION: Estimates of the cost-effectiveness ratios of this mass media campaign in preventing the onset of smoking showed it to be economically attractive and to compare favourably with other preventive and therapeutic strategies.


     

The costs of smoking in Vietnam: the case of inpatient care

Objective

To estimate the social costs of smoking related to inpatient care in Vietnam using 2005 data.

Design

The cost of illness as a result of hospitalisation for three major smoking‐related diseases combined with the prevalence‐based approach to obtain the costs of smoking in Vietnam for inpatient care.

Main outcome measure

Smoking‐attributable costs of inpatient care for lung cancer, chronic obstructive pulmonary disease (COPD), and ischaemic heart disease.

Results

The total cost of inpatient health care caused by smoking in Vietnam reached at least 1 161 829 million Vietnamese dollars ($VN) (or $US77.5 million) in 2005. This represents about 0.22% of Vietnam gross domestic product (GDP) and 4.3% of total healthcare expenditure. The majority of these expenses are related to COPD treatment ($VN1 033 541 million or $US68.9 million per year) followed by lung cancer ($VN78 143 million, or $US5.2 million per year) and ischaemic disease ($VN50 145 million, or $US3.3 million per year). The government directly finances about 51% of these costs. The rest is financed either by households (34%) or by the insurance sector (15%).

Conclusions

The social costs of smoking in Vietnam as the percentage of GDP is lower compared to estimates from high‐income countries. The true costs would be substantially higher if all smoking‐related diseases, outpatient care and mortality‐related costs are included. More research is needed to augment the estimates presented in this paper.     

Examining the effects of tobacco treatment policies on smoking rates and smoking related deaths using the SimSmoke computer simulation model

OBJECTIVES: To develop a simulation model to predict the effects of different smoking treatment policies on quit rates, smoking rates, and smoking attributable deaths. METHODS: We first develop a decision theoretic model of quitting behaviour, which incorporates the decision to quit and the choice of treatment. A model of policies to cover the costs of different combinations of treatments and to require health care provider intervention is then incorporated into the quit model. The policy model allows for the smoker to substitute between treatments and for policies to reduce treatment effectiveness. The SimSmoke computer simulation model is then used to examine policy effects on smoking rates and smoking attributable deaths. RESULTS: The model of quit behaviour predicts a population quit rate of 4.3% in 1993, which subsequently falls and then increases in recent years to 4.5%. The policy model suggests a 25% increase in quit rates from a policy that mandates brief interventions and the coverage of all proven treatments. Smaller effects are predicted from policies that mandate more restricted coverage of treatments, especially those limited to behavioural treatment. These policies translate into small reductions in the smoking rate at first, but increase to as much as a 5% reduction in smoking rates. They also lead to substantial savings in lives. CONCLUSIONS: Tobacco treatment policies, especially those with broad and flexible coverage, have the potential to increase smoking cessation substantially and decrease smoking rates in the short term, with fairly immediate reductions in deaths.     

Economic burden of smoking in Korea

Objective: To support tobacco control policies in Korea by providing the estimated annual economic burden attributed to cigarette smoking.

Methods: The following two different approaches were used to estimate the cost: "disease specific" and "all causes". In the disease specific approach, we focused on estimating direct and indirect costs involved in treatments of cardiovascular, respiratory, and gastrointestinal diseases, and cancer as a result of smoking, by using an epidemiologic approach—the population attributable risk (PAR). To compute PAR, the relative risks of smoking in terms of physician visits, hospital admission, and death were estimated using the Cox proportional hazard model. In the all causes approach, we examined the differences in direct and indirect costs between smokers and non-smokers for all conditions and types of disease. The major data source was the Korea Medical Insurance Corporation cohort study, which had complete records of smoking status as of 1992 for 115 682 male and 67 932 female insured workers.

Results: By the disease specific approach, the estimated costs attributable to smoking in 1998 in Korea ranged from US$2269.42 million ($4.89 million per 100 000 population; 0.59% of gross domestic product (GDP)) to $2956.75 million ($6.37 million; 0.78% of GDP). The all causes approach yielded a minimum cost of $3154.75 million ($6.79 million; 0.82% GDP) and a maximum of $4580.25 million ($9.86 million; 1.19% GDP).

Conclusion: The study confirms that smoking places a substantial economic burden on Korean society. In light of this, our study provides evidence for a strong need to develop a national policy to effectively control tobacco consumption in Korea.

     

Regional, disease specific patterns of smoking-attributable mortality in 2000

Background: Smoking has been causally associated with increased mortality from several diseases, and has increased considerably in many developing countries in the past few decades. Mortality attributable to smoking in the year 2000 was estimated for adult males and females, including estimates by age and for specific diseases in 14 epidemiological subregions of the world.

Methods: Lung cancer mortality was used as an indirect marker of the accumulated hazard of smoking. Never-smoker lung cancer mortality was estimated based on the household use of coal with poor ventilation. Estimates of mortality caused by smoking were made for lung cancer, upper aerodigestive cancer, all other cancers, chronic obstructive pulmonary disease (COPD), other respiratory diseases, cardiovascular diseases, and selected other medical causes. Estimates were limited to ages 30 years and above.

Results: In 2000, an estimated 4.83 million premature deaths in the world were attributable to smoking, 2.41 million in developing countries and 2.43 million in industrialised countries. There were 3.84 million male deaths and 1.00 million female deaths attributable to smoking. 2.69 million smoking attributable deaths were between the ages of 30–69 years, and 2.14 million were 70 years of age and above. The leading causes of death from smoking in industrialised regions were cardiovascular diseases (1.02 million deaths), lung cancer (0.52 million deaths), and COPD (0.31 million deaths), and in the developing world cardiovascular diseases (0.67 million deaths), COPD (0.65 million deaths), and lung cancer (0.33 million deaths). The share of male and female deaths and younger and older adult deaths, and of various diseases in total smoking attributable deaths exhibited large inter-regional heterogeneity, especially in the developing world.

Conclusions: Smoking was an important cause of global mortality in 2000, affecting a large number of diseases. Age, sex, and disease patterns of smoking-caused mortality varied greatly across regions, due to both historical and current smoking patterns, and the presence of other risk factors that affect background mortality from specific diseases.

     

Cost of tobacco-related diseases, including passive smoking, in Hong Kong

Background

Costs of tobacco‐related disease can be useful evidence to support tobacco control. In Hong Kong we now have locally derived data on the risks of smoking, including passive smoking.

Aim

To estimate the health‐related costs of tobacco from both active and passive smoking.

Methods

Using local data, we estimated active and passive smoking‐attributable mortality, hospital admissions, outpatient, emergency and general practitioner visits for adults and children, use of nursing homes and domestic help, time lost from work due to illness and premature mortality in the productive years. Morbidity risk data were used where possible but otherwise estimates based on mortality risks were used. Utilisation was valued at unit costs or from survey data. Work time lost was valued at the median wage and an additional costing included a value of US$1.3 million for a life lost.

Results

In the Hong Kong population of 6.5 million in 1998, the annual value of direct medical costs, long term care and productivity loss was US$532 million for active smoking and US$156 million for passive smoking; passive smoking accounted for 23% of the total costs. Adding the value of attributable lives lost brought the annual cost to US$9.4 billion.

Conclusion

The health costs of tobacco use are high and represent a net loss to society. Passive smoking increases these costs by at least a quarter. This quantification of the costs of tobacco provides strong motivation for legislative action on smoke‐free areas in the Asia Pacific Region and elsewhere.     

Cumulative discounted expressions of sire genotypes for the complex vertebral malformation and beta-casein loci in commercial dairy herds

Based on discounted gene-flow principles, a set of recursive equations was developed to quantify the value of using sires with a specific genotype for an identified gene in a commercial dairy herd. Two examples were used to demonstrate the usefulness of the method. The first example deals with the implications of using sires that are known carriers of the lethal recessive genetic defect, complex vertebral malformation (CVM). The second example examines the value of using sires homozygous for the A2 allele of β-casein. Results are presented in terms of cumulative discounted expressions. These are then multiplied by the economic values of specific genotypes to determine the cost or benefit of using these sires. In general, the degree of mortality and the required price reduction for carrier sires increased as the proportion of carrier sires used, the duration of sire use, and the initial frequency in the cow herd increased. A semen discount of £3.10 per CVM straw used would be required to offset the expected mortality when 20% of CVM carrier sires are used for 3 yr when 5% of cows are carriers. The cumulative discounted expressions’ of using sires homozygous for the A2 allele of β-casein also increased when the proportion and duration of carrier sire use and the initial frequency of the A2 allele increased. Assuming an A2A2 cow is worth £160 more than a non-A2A2 cow, the expected benefit of using A2A2 sires in a 100-cow herd for 5 yr would be £57,120 for a 20-yr planning horizon. The results of this study demonstrate how the starting gene frequency in the herd, and the proportion and duration of use of sires of particular genotypes are critical to the economic implications of using single genes in commercial dairy farms.     

The association of smoking and the cost of military training

OBJECTIVE: To determine if premature discharge from the US Air Force was associated with the smoking status of recruits. DESIGN AND SETTING: A total of 29 044 US Air Force personnel recruited from August 1995 to August 1996 were administered baseline behavioural risk assessment surveys during basic military training. They were tracked over a 12 month period to determine those who were prematurely discharged. MAIN OUTCOME MEASURES: Excess training costs as a result of premature discharge. RESULTS: In this 12 month period, 14.0% of those entering the US Air Force were discharged at a one year follow up. In both univariate and multivariate models, the best single predictor of early discharge was smoking status. Overall, 11.8% of non-smokers versus 19.4% of smokers were prematurely discharged (relative risk 1.795). CONCLUSIONS: Using US Department of Defense data on the cost of military training, recruits who smoke in the US Air Force are associated with $18 million per year in excess training costs. Applied to all service branches, smoking status, which represents a constellation of underlying behaviours and attitudes that can contribute to early discharge, is associated with over $130 million per year in excess training costs.     

Cost-effectiveness of reducing sulfur emissions from ships

We model cost-effectiveness of control strategies for reducing SO2 emissions from U.S. foreign commerce ships traveling in existing European or hypothetical U.S. West Coast SO(x) Emission Control Areas (SECAs) under international maritime regulations. Variation among marginal costs of control for individual ships choosing between fuel-switching and aftertreatment reveals cost-saving potential of economic incentive instruments. Compared to regulations prescribing low sulfur fuels, a performance-based policy can save up to $260 million for these ships with 80% more emission reductions than required because least-cost options on some individual ships outperform standards. Optimal simulation of a market-based SO2 control policy for approximately 4,700 U.S. foreign commerce ships traveling in the SECAs in 2002 shows that SECA emissions control targets can be achieved by scrubbing exhaust gas of one out of ten ships with annual savings up to $480 million over performance-based policy. A market-based policy could save the fleet approximately $63 million annually under our best-estimate scenario. Spatial evaluation of ship emissions reductions shows that market-based instruments can reduce more SO2 closer to land while being more cost-effective for the fleet. Results suggest that combining performance requirements with market-based instruments can most effectively control SO2 emissions from ships.     

The effect of climate change on the water and food nexus in China

A country level food security approach called PODIUMSim model was applied in this paper to analyse the likely food surplus/deficit in China in the years 2030 and 2050 based on population growth and irrigation area development scenarios. PODIUMSim is an interactive policy planning and scenario analysis tool, which explores the trade-offs and future demands on water resources at a national scale. Changes in precipitation and evapotranspiration estimated from climate models are used to represent climate change. A decision support tool for stochastic analysis called @RISK was used to perform stochastic analysis on future water availability and water demand. Without climate change the results indicate that total grain demand in China would increase from 427 million tons in 2000 to 609 million tons by 2030 and 714 million tons by 2050 while the total grain production was 400 million tons in 2000 and would increase to 521 million tons and 629 million tons in 2030 and 2050, respectively. There was a 27 million ton grain deficit in the year 2000 and there would be an 88 million ton and 85 million ton grain deficit in 2030 and 2050, respectively, under medium population growth and irrigation area development scenarios. To meet the total food demand in 2030 and 2050 in the high population growth scenario, 107.8 and 104.7 million ha of gross irrigated area need to be reached respectively, which requires 48% and 73% of surface water and groundwater irrigation efficiencies in the year 2030 and 49% and 75% of surface water and groundwater irrigation efficiencies in the year 2050, subject to the constraint of irrigation water use being between 400 and 420 billion m³, as set by the Chinese government. Achieving these gains in both gross irrigated area and irrigation efficiency at the country levels is a formidable task, requiring further intensification of land and water use. To meet the total food, domestic and industrial demand, the total water production will have to increase from 564 billion m³ in 2000 to 600 and 615 billion m³ in 2030 and 2050, respectively. In addition, climate change will have significant impacts on future water availability and irrigation water demand. Under climate change (precipitation increased by 3% and evapotranspiration increased by 0.03 mm day⁻¹) in 2030, the surface water availability would decrease from 951 billion m³ to 914 billion m³ and groundwater availability would decrease from 383 billion m³ to 378 billion m³. To cope with the impacts from climate change, some mitigation measures such as investing in drought resistant crops, expanding water storage schemes, and increasing irrigation water use efficiencies should be adopted.     

Effect of clean indoor air laws on smokers: the clean air module of the SimSmoke computer simulation model

OBJECTIVES: To develop a simulation model to examine the effects of clean indoor air laws on prevalence rates and smoking attributable deaths. METHODS: Based on empirical and theoretical research, the effects of clean air laws are modelled by type of law. The model considers clean air laws at the state levels between 1993 and 2000, and projects the number of smokers and smoking attributable deaths in the USA under different scenarios from 2000 onward. RESULTS: The model predicts that comprehensive clean air laws have the potential to reduce substantially the number of smokers and smoking attributable deaths, and these effects are predicted to grow over time. The predicted impact of new worksite laws are reduced when previously implemented private and public worksite restrictions are taken into account. CONCLUSIONS: Clean indoor air laws have the ability to reduce smoking rates substantially and save lives, but their impact is likely to depend on their comprehensiveness and prior private worksite restrictions in place.     

Use of “colorants replacement technique” in order to reduce the amount of dye consumed in textile dyeing processes

Achieving black color in a trichromatic system has been a problem in printing systems and attempts to solve the problem ended in adding black color to the trichromatic system. One of the advantages of this solution is the reduction in other colorants consumption. Since black dyes are the cheapest among most types of dyes in the textile industry, if this solution could be used in the dyeing process, the costs would be reduced and the process would be more economical. In this paper, two methods for using this solution in a dyeing process are proposed and investigated. Both the methods reduce the colorants consumption (up to 50%) and the process cost, with a tolerable color difference to the target. However, depending on the colorants selection, one of the methods would be more effective.     

Impact of UK National Health Service smoking cessation services: variations in outcomes in England

Objectives: To determine the extent to which UK National Health Service (NHS) smoking cessation services in England reach smokers and support them to quit at four weeks, and to identify which service and area characteristics contribute to observed outcomes.

Design: Ordinary least squares regression was used to investigate local smoking outcomes in relation to characteristics of health authorities and their smoking cessation services.

Setting: 76 health authorities (from a total of 99) in England from April 2000 to March 2001.

Main outcome measures: Reach—number of smokers attending cessation services and setting a quit date as a percentage of the adult smoking population in each health authority. Absolute success—number of smokers setting a quit date who subsequently reported quitting at four weeks (not having smoked between two and four weeks after quit date). Cessation rate—number of smokers who reported quitting at four weeks as a percentage of those setting a quit date. Loss—percentage lost to follow up.

Results: A range of service and area characteristics was associated with each outcome. For example, group support proved more effective than one to one interventions in helping a greater proportion of smokers to quit at four weeks. Services based in health action zones were reaching larger numbers of smokers. However, services operating in deprived communities achieved lower cessation rates than those in more prosperous areas.

Conclusions: Well developed, evidence based NHS smoking cessation services, reflecting good practice, are yielding positive outcomes in England. However, most of the data are based on self reported smoking status at four weeks. It will be important to obtain validated data about continuous cessation over one year or more in order to assess longer term impact.