BACKGROUND: The burden of smoking in Brazil remains high despite the success of various measures implemented over the past two decades.This study estimated the burden of smoking in terms of mortality, morbidity, and economic and social costs from a societal perspective and the potential benefits of increasing taxes on tobacco products, considering the effects of the illegal market.

METHODS: A probabilistic Markov microsimulation model was applied, in which individuals aged 35 and older were followed in hypothetical cohorts. This model quantified the number of deaths, health events, direct healthcare costs, and indirect costs due to productivity losses. A model was also developed to estimate the health and economic gains from different tax increase scenarios over ten years, including illegal market. Data on smoking prevalence, Brazil’s demographic structure, mortality, and morbidity were obtained from official databases and the literature. Healthcare resource utilization was gathered through the literature and consultations with experts. A literature review on informal caregivers’ time use was carried out focusing on the tobacco-related diseases. Cost estimates were expressed in 2024 US dollars.
RESULTS: Smoking caused 174000 deaths and 5.7 million years of life lost due to premature mortality and disability. The economic burden amounted to US 26 billion, with US 11 billion attributed to direct costs and US 8 billion to indirect costs. Informal caregiver costs reached US 7 billion. These economic losses represent 1.6% of country gross domestic product. In the scenario that includes the illegal tobacco product market, a 50% increase in cigarette prices has the potential to generate economic benefits of US 27 billion over ten years.
CONCLUSIONS: This is a cost-effective measure that could reduce the burden of smoking and increase fiscal revenue. The ongoing Tax Reform is a timely opportunity for the country to adopt a permanent pricing and tax policy.