OBJECTIVES : The prevalence of smoking among Indonesian males, especially those of working age, is the highest in the world, and smoking-related impact on productivity at population levels in Indonesia remains unknown. To estimate the impact of smoking in the Indonesian population of working-age in terms of costs, years of life, quality-adjusted life years (QALYs) and productivity-adjusted life years (PALYs) lost.

METHODS : Life-table modelling of Indonesian smokers age 15 to 54 years, followed-up until 55 years (retirement age). Contemporary data on demographic, mortality and prevalence of smoking were derived from the Institute for Health Metrics and Evaluation and the World Health Organisation. The population attributable risk, quality of life and reduction in productivity due to smoking were derived from published sources. The analysis was repeated but with the assumption the cohorts were non-smokers. The differences in results represented the losses incurred by smoking. Gross domestic product (GDP) per equivalent full-time (EFT) worker (USD 11,765) was used for estimation of the cost of each PALY, and annual discount rate of 6% was applied to all costs and outcomes.

RESULTS : The prevalence of smoking among Indonesian working-age males and females were 67.0% and 7.9%, respectively. This study estimated that smoking caused 667,556 excess deaths, 1.6 million years of life lost (0.26%, 0.03 per person), 32.9 million QALYs lost (5.74%, 0.57 per person) and 11.9 million PALYs lost (2.16%, 0.21 lost per person). The total cost of productivity loss due to smoking amounted to USD 139.8 billion. Healthcare costs devoted to smoking-associated diseases was predicted to be USD 1.6 trillion.

CONCLUSIONS : Smoking imposes a significant health and economic burden in Indonesia. The findings of this study stress the importance of developing effective tobacco control strategies, which would benefit the country both in terms of health and wealth.