OBJECTIVES: Smoking has a tremendous impact on public health and has been a cause of major concern in Greece for more than twenty years.Ιn times of economic recession when household income drops and health spending is decreasing, the demand for health services is transferred to the public sector. In light of the above, the aim of this study was to measure the number of smoking-related hospitalizations and the additional hospital costs for the treatment of smoking-attributable diseases.  METHODS: A prevalence-based disease specific approach was used for the calculations. Greek-specific smoking-attributable fractions (SAFs) were calculated for all smoking-related diseases, coded according to the International Classification of Diseases ICD-10. Smoking attributable morbidity was obtained by applying the SAFs to all public hospital admissions for 2011. Total hospital costs associated with smoking were calculated by applying the smoking-attributable admissions to each DRG rate.   RESULTS: For Greece, lung cancer (C33-C34), bronchitis and emphysema (J40-J42, J43) presented the highest disease-specific SAF with a value of 88.4% and 88.1% respectively. In 2011, smoking was responsible for 199,028 hospital admissions (8.9 % of total). Smoking-attributable hospital costs, based on the current pricing DRG system, has reached 400,011,801€ representing 7.7% of public hospital budgets. Ischemic heart disease (I20-I25) was found to be the main cost driver (90.3 million €), followed by other circulatory diseases (I00-I09, I26-I51) (55.8 million€) and pneumonia, influenza (J10-J18) (52.6 million €). CONCLUSIONS: Despite evidence of a decreasing trend, smoking is still a considerable public health issue in Greece and has a great impact on public healthcare system. Vigorous efforts have been implemented to promote a smoke-free environment and to enforce existing anti-smoking legislation however the Greek society still experiences a high proportion of smoking-attributable admissions and hospital treatment costs.Τhe findings of this study further corroborate a call for stronger support of cost-effective tobacco control policies.