Mohammad Bakhtiari Aliabad - Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
Iravan Masoudi-Asl - Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
Masoud Abolhallaje - Ministry of Health and Medical Education, National Center for Strategic Research in Medical Education, Tehran, Iran
Mehdi Jafari - Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Background: Tobacco is a major cause of preventable morbidity and mortality, with a considerable economic burden. The purpose of this systematic review was to summarize the evidence on the economic burden of tobacco use by searching national and international databases so as to generate useful information about the costs of tobacco use globally.Methods: A systematic search was conducted in Scopus, PubMed, EMBASE, ProQuest, and Web of Science (ISI) databases to identify relevant studies from ۱۹۹۰ to June ۲۰۲۱ using keywords like burden, productivity, indirect cost, direct cost, economic, monetary, expenditure, tobacco, smoking, and cigarettes. Cost estimates were converted into ۲۰۲۰ international dollars per adult.Findings: A total of ۱,۷۸۱ articles were identified, of which ۳۶۱ were deemed to be eligible for inclusion. Eventually, ۲۳ articles were found eligible. In most studies, cost estimates were provided using a prevalence-based approach. The highest total cost, as a percentage of gross domestic product (GDP), was reported for South Korea (۱.۱۹%). Noteworthy, in all studies, indirect costs accounted for the highest proportion of all costs. The mean total cost amounted to ۵,۸۶۶ million dollars. The direct costs ranged from ۱۷۹ million dollars in South Korea to ۸,۱۵۶ million dollars in Israel. Meanwhile, the indirect costs ranged from ۲۸۹ million dollars in Hong Kong to ۹,۸۰۸ million dollars in India. Conclusion: The evidence demonstrated the considerable economic burden of tobacco use in various countries, ranging from ۰.۳۳ to ۱.۱۹% of the GDP of the investigated countries, indicating the necessity of taking immediate measures. Hence, policies are needed to address the economic burden of smoking.

Tobacco, Economic burden, Total cost, Systematic review