Burden of disease attributable to tobacco use and impact of different taxation schemes in Latin America

Abstract

Background Tobacco use is the leading cause of preventable deaths worldwide. The objective of this study was to estimate the burden of disease attributable to tobacco use and to evaluate the potential impact of increasing cigarette´s price through taxes in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru and Uruguay-countries which encompass 84% of Latin America´s population. Methods A microsimulation model was used to estimate the chances people have to get sick or die from 17 smoking-related conditions. An extensive review was conducted to identify key epidemiological and cost data relevant to each country. Results Every year, smoking is responsible for 293,364 deaths, 862,484 COPD cases (Chronic Obstructive Pulmonary Disease), 832,791 cardiovascular events, 131,037 cancer diagnoses and 28,098 USD millions in direct medical costs to the health systems in these countries. The proportion of health expenditure that these burden represent range from 3.2% in Honduras to 16,6% in Uruguay; and the proportion of the total GDP (Gross Domestic Product) ranged from 0.3% to 1.5% respectively. The percentage of attributable health expenditures recovered through tobacco taxes also varies widely: Mexico, Honduras, Argentina and Chile recover over 45%; in Ecuador tax revenues reach 40%; Brazil, Costa Rica, Paraguay and Uruguay recover less than 30%, and Bolivia, Colombia and Peru, less than 10%. Different scenarios of cigarette price increases through taxes were modeled for each country. An example -the case for Brazil- is shown in the table below. Cigarette price increase through taxes 25% 50% 100% Avoided deaths 68,241 136,482 272,964 Avoided events 336,099 672,199 1,344,398 Direct costs avoided (USD millions) 4,866 9,732 19,464 Indirect costs avoided (USD millions) 2,995 8,980 8,411 [Potential benefts on different scenarios, Brazil] Conclusions The burden of disease and related direct health expenditure in Latin America is very high and tax revenues from the sale of tobacco products are far below the levels needed to cover it. Increasing cigarette´s price through taxes is an effective intervention to reduce tobacco-attributable burden of disease and health expenditures in Latin America.

Keywords

• WCTOH