Smoking and mental health - NCSCT

8
The economic cost of smoking in people
with mental disorders
8.1 Introduction
In the UK in 2009–10 the cost imposed on society as a result of the healthand
social care costs, human costs and output losses attributable to mental
disorders were estimated at over £105bn. 1,2 In the same year, mental health
services accounted for approximately 14% of the annual NHS budget. 3 The
economic burden of smoking is estimated at over £14bn in total costs to
society, including over £5bn to the NHS, each year. 4 Mental disorders and
smoking therefore both impose substantial economic burdens on healthcare
services and wider society, but, in contrast to those of mental disorders alone,
the costs of smoking are entirely preventable. This chapter aims to estimate
the economic costs to the NHS of smoking among people with mental
disorders. Annual costs associated with smoking in patients with mental
disorders in the UK were assessed from the NHS personal social services (PSS)
perspective, based on the population estimates of the number of people in the
UK with mental disorders and the numbers of those who smoke, presented in
Chapter 2. All costs are estimated in pounds sterling for the 2009–10 financial
year.
8.2 Estimating the costs of diseases caused by smoking in
people with mental disorders
Smoking causes or exacerbates many diseases, but most of the mortality and
morbidity caused by smoking at population level arise from effects on the risk of
lung cancer, cardiovascular disease and chronic obstructive pulmonary disease. 5,6
To estimate the ensuing economic costs of healthcare provision for diseases
caused by smoking in people with mental disorders, we have used the
attributable risk approach 7,8 as originally devised by Levin, 9 and tailored and
widely used in the estimation of smoking-attributable health outcomes. 5,10–12
The proportion of disease attributable to smoking in current and former
smokers compared with never smokers is estimated from the relative risks of
disease and prevalence of exposure using the following formula:
164 © Royal College of Physicians 2013