Pilot study: tobacco-attributable direct costs in two hospitals in Santiago, Chile

Tobacco is the fourth cause of the global burden of disease, accounting for 79.9 million loss of disability-adjusted life years (DALYs) in 2001. In 2002, tobacco-attributable mortality in Chile represented 17% of total mortality. To estimate the direct cost of tobacco in Ischemic Heart Disease, Chronic Obstructive Pulmonary Disease and Lung Cancer, explore patients' disposition to answer a health related expenses questionnaire, validate the instruments used and determine an adequate sample size for an upcoming study. Socio-demographic and health care related variables were investigated among patients attending two public hospitals for ischemic heart disease, chronic obstructive pulmonary disease and lung cancer, in a cross-sectional study. Costs were estimated using the national public health insurance price list and market prices. Tobacco-attributable fraction was then applied to calculate the tobacco-attributable cost of each disease. The instruments used were validated. The group of lung cancer patients was smaller due to increased mortality prior to interview. Lung cancer generated the largest total and attributable direct costs. The costs in patients with ischemic heart disease were significantly lower There were some difficulties in the application of the questionnaire to register medication use. The sample size needed in a larger study was calculated for each of the three diseases. We recommend that a definitive study addresses tobacco-attributable direct costs related to chronic obstructive pulmonary disease.