The economic cost of direct smoking in South Korea

•The estimated socioeconomic cost of firsthand cigarette smoking in Korea was USD 10.9 billion in 2020, representing 0.67 % of the gross domestic product.•The largest component of the total cost was the loss of productivity resulting from premature death, followed by medical costs and productivity loss due to medical utilization.•The majority of the total cost was attributed to males, representing 90.4 % of the total, due to their higher smoking rates. Cancer costs constituted 40.0 % of the total cost, resulting in the greatest disease burden.•The application of the value of statistical life (VSL) to calculate the productivity loss due to premature death resulted in an increased cost estimate of USD 270.9 billion. Smoking not only causes negative health outcomes for individuals but also causes an economic burden to society. This study estimated the socioeconomic costs of direct smoking in South Korea in 2020. We used the prevalence-based cost-of-illness approach to estimate the sum of the direct (medical, transportation, and caregiving) and indirect (productivity loss due to health service utilization and premature death) costs of 41 smoking-related diseases. We assumed that diseases with death-based hazard ratios greater than 1.0 were related to smoking and used them in cost estimation. The socioeconomic cost of direct smoking in Korea was USD 10.9 billion in 2020, accounting for 0.67 % of the gross domestic product and 8.0 % of current health expenditures. The direct cost was USD 4,172 million and the indirect cost was USD 6,753 million. The cost of productivity loss due to premature death took up the largest amount of the total cost, accounting for 52.3 %. The amount attributed to males accounted for 90.4 % of the overall cost, totaling to USD 9,877 million. This is attributable to higher smoking rates and higher medical costs in men. Cancer costs accounted for 40.0 % of the total cost, causing the greatest burden of diseases. Direct smoking imposed a harmful and heavy economic burden on South Korea. Our estimate provides the latest evidence on the financial burden of smoking and strengthens the case for strong tobacco control policies and interventions.