Author: Jan Barendregt
Position: Associate Professor
Institution: School of Population Health, University of Queensland
E-mail: j.barendregt@sph.uq.edu.au
Submitted Date: August 26, 2008
Published Date: August 27, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Lightwood, Dinno, and Glantz conclude: "A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures". This would be true if they would have added "in the short run".
Per capita health care costs of smokers are indeed higher than those of non-smokers. However, non-smokers live longer than smokers, and are therefore on balance making more health care costs, in particular at high age when many degenerative diseases occur. As we have shown (Barendregt JJ, Bonneux L, Maas PJ, van der. The health care costs of smoking. N Eng J Med. 1997;337:1052-7), smoking cessation on the population level at first decreases health care costs (because non- and ex-smokers are less expensive when alive), but in the end health care costs become higher (because non- and ex-smokers live longer and therefore the population ages).
In our simulation we found that after an abrupt complete smoking cessation health care costs would be lower for about 15 years, and then become higher than would have been the case with continued smoking. In California the smoking cessation has been spread out over many years, therefore the time lag will be longer. But in the long run we can expect health care costs to be higher in a non-smoking population. Which is why we warned against using the health care expenditure argument as one favouring anti-smoking interventions.