OBJECTIVES: In Belgium, despite a 40% decrease in the number of daily smokers since 1997, the prevalence of tobacco use remains high (19%). Tobacco use is among the leading behavioural risk factors for morbidity and mortality. These high rates result in a high cost to society. Therefore, the aim of the current study was to provide a contemporary overview of the direct medical and indirect costs attributable to smoking tobacco in Belgium.

METHODS: Data from the Belgian Health Interview Survey (BHIS) was combined with health insurance claims data (reference year 2018). Healthcare costs were calculated on individuals’ tobacco use patterns (daily, former, and non-smokers). Lost productivity costs (i.e. cost of absenteeism) were calculated by multiplying the number of absence days by the national average wage cost per day in Belgium. Univariate and multivariable regression analysis with negative binomial distribution and log link were performed to evaluate the average healthcare costs and indirect costs in relation to tobacco use, sociodemographic characteristics, and (behavioural) risk factors. Incremental costs were calculated using the G-computation method.

RESULTS: A total of 10,829 individuals were included in the analyses, of which 47.7% were men with 15% being smokers. Men were more likely to be smokers than women (56.8% vs. 43.2%; P<0.001). Compared to non-smokers, significantly higher direct medical costs were found for daily (21%; P=0.02) and former smokers (26%; P<0.001). The adjusted mean attributable cost for daily smokers was estimated at €311. No significant differences were observed for the indirect costs for the smoking population compared to non-smokers. Taking into account that 15% of the Belgian population were daily smokers in 2018, the national cost for daily tobacco use equates to €533.861.010 per year.

CONCLUSIONS: Results of our study show that tobacco use has higher direct medical costs compared with non-smokers. No significant differences were found for productivity losses.