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  1. Simone Neubauer1,
  2. Robert Welte1,
  3. Alexandra Beiche2,
  4. Hans-Helmut Koenig3,
  5. Katharina Buesch1,
  6. Reiner Leidl1
  1. 1GSF-National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
  2. 2Department of Surgery, General Hospital Laupheim, Laupheim, Germany
  3. 3Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany
  1. Correspondence to:  S Neubauer  GSF-National Research Center for Environment and Health, Institute of Health Economics and Health Care Management, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany; simone.neubauer{at}


Objective: To assess the negative health consequences and associated costs of cigarette smoking in Germany in 2003 and to compare them with the respective results from 1993.

Methods: The number of deaths, years of potential life lost (YPLL), direct medical and indirect costs caused by active cigarette smoking in Germany in 2003 is estimated from a societal perspective. The method is similar to that applied by Welte et al, who estimated the cost of smoking in Germany in 1993. Therefore, a direct comparison of the results was possible. Methodological and data differences between these two publications and their effect on the results are analysed.

Results: In 2003, 114 647 deaths and 1.6 million YPLL were attributable to smoking. Total costs were €21.0 billion, with €7.5 billion for acute hospital care, inpatient rehabilitation care, ambulatory care and prescribed drugs; €4.7 billion for the indirect costs of mortality; and €8.8 billion for costs due to work loss days and early retirement. From 1993 to 2003, the proportionate mortality attributable to smoking remained relatively stable, rising from 13.0% to 13.4%. The smoking-attributable deaths in men is lowered by 13.7% whereas that in women increased by 45.3%. Total real direct costs rose by 35.8%, and total real indirect costs declined by 7.1%, rendering an increase of 4.7% to real total costs. Accountable factors are changes in cigarette smoking prevalence and in disease-specific mortality and morbidity, as well as a rise in general healthcare expenditure.

Conclusions: Despite the growing knowledge about the hazards of smoking, the smoking-attributable costs increased in Germany. Further, female mortality attributable to smoking is much higher than it was in 1993.

  • CPS, Cancer Prevention Survey
  • ICD, International Classification of Diseases
  • SAF, smoking-attributable fraction
  • YPLL, years of potential life lost

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  • Competing interests: None declared.

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