Excess healthcare cost associated with a low smoking prevalence, Barbados

Policy makers need justification for smoking prevention. Barbados has debated but not enacted policies on tobacco control. This study estimated tobacco-associated morbidity and hospital care costs in order to justify prevention in a developing country with a low smoking prevalence of 9%. Hospital files of patients of index diseases and other chronic diseases with recorded status of smoking were followed on their outpatient, inpatient, elective and emergency attendance up to last discharge and analyzed as a nested case-control in a cohort of smokers and non-smokers. Outcome measure was excess healthcare financial burden per person per year derived from morbidity incidence density, risk ratios, preventive fractions and excess hospital services consumed per person per year. Of 258 hospital patients, 84 were smokers. The mean follow up was 5.2 years. Eighty-four smokers had 463 excess outpatient appointments, 43 excess admissions, and 2651.6 excess hospital days. There were 44.8 fewer elective admissions and 62.24 more emergency admissions among smokers who suffered frequent and severer complications, (odds ratio = 3.78 for > or = 3 complications, p for Chi square trend, 0.0223), and had poorer prognosis translating into higher care costs, personnel effort, time, and human suffering. The excess hospital care cost was BDS$2,267 per smoker per year. Despite a low prevalence of smoking, tobacco caused a substantial public health burden. Hospital care cost for patients who smoked was 1.86 times higher than for non-smokers, and five times more than the government per capita health allocation. The annual excess hospital care costs in 1556 similar smokers would have exceeded the annual tobacco revenue.