The economic burden of cancers attributable to smoking in Korea, 2014
Minji Han 1
Jin-Kyoung Oh 1, 2  
More details
Hide details
Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
Jin-Kyoung Oh   

Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
Publish date: 2019-02-28
Tob. Induc. Dis. 2019;17(February):15
Associations between smoking, cancer and mortality are well established. Although cancer mortality rates have decreased in recent years, the economic burden of smoking-related cancers continues to increase. This study investigates the economic costs of cancers related to smoking in Korea in 2014.

Cancer patients were identified through National Health Insurance Services medical claims with ICD-10 cancer codes. We multiplied the costs by the population attributable fraction for each type of cancer and calculated direct and indirect costs, where direct costs comprise direct medical and non-medical costs of inpatients and outpatients, and indirect costs include estimates of future income loss due to premature death, productivity loss during hospitalization and outpatient visits, and job loss.

In 2014, there were 79297 smoking-related cancer patients, accounting for 8.47% of all Korean cancer cases for that year. The direct cost of cancers due to smoking was approximately 595 million USD, whereas indirect costs were much higher, at nearly 2.2 billion USD. The average expenditure of a typical patient was 34815 USD. Lung, liver and stomach cancers were most prevalent and represented the most significant share of the economic burden, whereas the largest per-patient spending was for pancreatic, liver, and lung cancers. Lung, liver and stomach cancers had the highest economic impact on men, while lung, liver and ovarian cancers had the most significant economic impact on women.

It is imperative that more stringent steps be taken to reduce the huge economic burden of cancers linked to smoking.

1. International Agency for Research on Cancer. Volume 100E - Personal habits and indoor combustions. Lyon: IARC; 2012.
2. National Center for Chronic Disease P, Health Promotion Office on S, Health. Reports of the Surgeon General. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention (US); 2014.
3. Jha P. Avoidable global cancer deaths and total deaths from smoking. Nat Rev Cancer. 2009;9:655-664. doi:10.1038/nrc2703
4. Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014;311(2):183-192. doi:10.1001/jama.2013.284692
5. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016;388:1659-1724. doi:10.1016/S0140-6736(16)31679-8
6. World Health Organization. WHO report on the global tobacco epidemic, 2017: monitoring tobacco use and prevention policies. Geneva: World Health Organization; 2017.
7. Chung CW, Wang JD, Yu CF, Yang MC. Lifetime medical expenditure and life expectancy lost attributable to smoking through major smoking related diseases in Taiwan. Tob Control. 2007;16(6):394-399. doi:10.1136/tc.2006.018986
8. Goodchild M, Nargis N, Tursan d'Espaignet E. Global economic cost of smoking-attributable diseases. Tob Control. 2018;27(1):58-64. doi:10.1136/tobaccocontrol-2016-053305
9. Korean Centers for Disease Control and Prevention, Korea Health Statistics 2016. Korea National Health and Nutrition Examination Survey. Osong: KCDC; 2018
10. Ha BM, Yoon SJ, Lee HY, Ahn HS, Kim CY, Shin YS. Measuring the burden of premature death due to smoking in Korea from 1990 to 1999. Public Health. 2003;117(5):358-365. doi:10.1016/s0033-3506(03)00142-2
11. Lim MK, Cho HJ. Current status of tobacco control policies in Korea compared with international treaty and its implementation. J Korean Med Assoc. 2018;61(3):148-156. doi:10.5124/jkma.2018.61.3.148
12. World Health Organization. FCTC Parties' reports: Republic of Korea. Accessed December 7, 2018.
13. Institute of Health Metrics and Evaluation. GBD compare. Accessed October 31, 2018.
14. Jung KW, Won YJ, Kong HJ, Lee ES. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2015. Cancer Res Treat. 2018;50(2):303-316. doi:10.4143/crt.2018.143
15. World Health Organization (WHO). Assessment of the Economic Costs of Smoking. Economics of Tobacco Toolkit. World Health Organization; 2011.
16. Zahra A, Cheong HK, Lee EW, Park JH. Burden of Disease Attributable to Secondhand Smoking in Korea. Asia Pac J Public Health. 2016;28(8):737-750. doi:10.1177/1010539516667779
17. Lee H, Yoon SJ, Ahn HS. Measuring the burden of major cancers due to smoking in Korea. Cancer Sci. 2006;97(6):530-534. doi:10.1111/j.1349-7006.2006.00205.x
18. Zahra A, Cheong HK, Park JH. Burden of Disease Attributable to Smoking in Korea. Asia Pac J Public Health. 2017;29(1):47-59. doi:10.1177/1010539516675696
19. Kang HY, Kim HJ, Park TK, Jee SH, Nam CM, Park HW. Economic burden of smoking in Korea. Tob Control. 2003;12(1):37-44. doi:10.1136/tc.12.1.37
20. Oh IH, Yoon SJ, Yoon TY, et al. Health and economic burden of major cancers due to smoking in Korea. Asian Pac J Cancer Prev. 2012;13(4):1525-1531. doi:10.7314/apjcp.2012.13.4.1525
21. Park S, Jee SH, Shin HR, et al. Attributable fraction of tobacco smoking on cancer using population-based nationwide cancer incidence and mortality data in Korea. BMC Cancer. 2014;14(1):406. doi:10.1186/1471-2407-14-406
22. National Health Insurance Service, Health Insurance Review & Assessment Service. National Health Insurance Statistical Yearbook. Wonju; 2016.
23. Cheol Seong S, Kim YY, Khang YH, et al. Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea. Int J Epidemiol. 2017;46:799-800. doi:10.1093/ije/dyw253
24. Korea Health Panel Study. Accessed October 31, 2018.
25. Statistics Korea. Cause of Death Statistics in 2014. Accessed October 31, 2018.
26. Korea Ministry of Employment and Labor. Survey Report on Labor Conditions by Employment Type. 2015.
27. National Health Insurance Services. Survey on the Benefit Coverage Rate of National Health Insurance in 2014. 2014.
28. Lee S, Chung W, Hyun KR. Socioeconomic costs of liver disease in Korea. Korean J Hepatol. 2011;17(4):274-291. doi:10.3350/kjhep.2011.17.4.274
29. Park JH, Park EC, Park JH, Kim SG, Lee SY. Job loss and re-employment of cancer patients in Korean employees: a nationwide retrospective cohort study. J Clin Oncol. 2008;26(8):1302-1309. doi:10.1200/jco.2007.14.2984
30. Exchange Rates. Korean Won Rates for 12/31/2014 US Dollar. 2014. Accessed October 31, 2018.
31. Lee S, Chung W, Hyun KR. Socioeconomic costs of liver disease in Korea. Korean J Hepatol. 2011;17(4):274-291. doi:10.3350/kjhep.2011.17.4.274
32. South Korea GDP - Gross Domestic Product. Published 2014. Accessed October 31, 2018.
33. Jung KW, Won YJ, Oh CM, et al. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2014. Cancer Res Treat. 2017;49:292-305. doi:10.4143/crt.2017.118
34. Rezaei S, Akbari Sari A, Arab M, Majdzadeh R, Mohammad Poorasl A. Economic burden of smoking: a systematic review of direct and indirect costs. Med J Islam Repub Iran. 2016;30:397.
35. Ruff LK, Volmer T, Nowak D, Meyer A. The economic impact of smoking in Germany. Eur Respir J. 2000;16(3):385-390. doi:10.1034/j.1399-3003.2000.016003385.x
36. Nonnemaker J, Rostron B, Hall P, MacMonegle A, Apelberg B. Mortality and economic costs from regular cigar use in the United States, 2010. Am J Public Health. 2014;104(9):e86-91. doi:10.2105/ajph.2014.301991
37. Kristina SA, Endarti D, Thavorncharoensap M. Burden of cancer attributable to tobacco smoking in member countries of the Association of Southeast Asian Nations (ASEAN), 2012. Cancer Epidemiol. 2016;44:84-90. doi:10.1016/j.canep.2016.08.005
38. Hoang Anh PT, Thu le T, Ross H, Quynh Anh N, Linh BN, Minh NT. Direct and indirect costs of smoking in Vietnam. Tob Control. 2016;25:96-100. doi:10.1136/tobaccocontrol-2014-05182
39. Sung HY, Wang L, Jin S, Hu TW, Jiang Y. Economic burden of smoking in China, 2000. Tob Control. 2006;15 Suppl 1:i5-11. doi:10.1136/tc.2005.015412
40. Jung KW, Won YJ, Oh CM, et al. Prediction of cancer incidence and mortality in Korea, 2015. Cancer Res Treat. 2015;47(2):142-148. doi:10.4143/crt.2015.066
41. National Law Information Center, Ministry of Government Legislation. Accessed October 31, 2018.
42. Health Insurance Review & Assessment Service. Accessed october31, 2018.
43. Seok Jun Yoon. A study on measuring and forecasting the burden of disease in Korea. 2015.
44. Kim D, Yoon SJ, Gong YH, et al. The Economic Burden of Cancers Attributable to Metabolic Syndrome in Korea. J Prev Med Public Health. 2015;48(4):180-187. doi:10.3961/jpmph.15.022
45. Jo C. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol. 2014;20(4):327-337. doi:10.3350/cmh.2014.20.4.327