The economic cost of tobacco smoking and secondhand smoke in Greece: Musculoskeletal disorders the leading contributor to smoking-related morbidity

INTRODUCTION: The high proportion of the population in Greece that is active and passive smoking makes smoking the leading risk factor for death and disability. Tobacco use creates a high cost to society and yet relevant research for Greece is limited. METHODS: The cost-of-illness approach is used to estimate the economic cost of smoking and, for the first time, of secondhand smoke (SHS) exposure in Greece. The analysis covers more health conditions, causally related to smoking, than those included in such studies. RESULTS: Based on data from the Global Burden of Diseases Study 2017, total economic cost of tobacco smoking and SHS exposure is estimated to be €7.2 billion in 2017, which is equivalent to almost 4% of GDP in Greece. SHS exposure accounts for 8.9% of total cost. Direct cost of smoking is slightly less than indirect cost. Indirect cost is relatively higher for males. Musculoskeletal disorders and diabetes are found to comprise the greatest fraction of morbidity cost of smoking and SHS exposure, respectively. Cardiovascular diseases are found to be the main cause of mortality costs for both smoking and SHS exposure. CONCLUSIONS: Total economic cost of tobacco smoking and SHS exposure in Greece is estimated to be more than double the revenue from tobacco taxes. Smoking imposes a heavy economic burden, underlining the need for efficient interventions, including effective implementation and enforcement of existing anti-tobacco policies.