[Cost-of-illness attributable to smoking: an overview of systematic reviews]

Tobacco use constitutes a major global public health problem. The objective of this study was to conduct an overview of reviews on the cost-of-illness attributable to tobacco use, provide a map of the available evidence, identify sources of methodological heterogeneity, assess the quality of the studies, and formulate recommendations for future research.

An overview of systematic reviews on tobacco cost-of-illness studies was conducted. Searches were performed in PubMed/MEDLINE, EMBASE, and Google Scholar (from January 1990 to June 2025). Results were synthesized narratively. The degree of overlap among primary studies was calculated, and the methodological quality of the systematic reviews was assessed using AMSTAR 2 and CiCERO.

Six systematic reviews (published between 1999 and 2020) encompassing 143 primary studies were included, with slight overlap among them. The cost-of-illness attributable to tobacco was estimated primarily in actively exposed populations, at the national level and on an annual basis, using prevalence-based approaches and considering multiple diseases, with emphasis on direct healthcare costs. Social costs of up to US$1.44 trillion worldwide (2012) were identified. All systematic reviews were rated as critically low according to AMSTAR 2.

Although most reviews identify a substantial economic impact of tobacco-attributable disease, comparability between estimation methods is low, and the methodological quality of systematic reviews still has room for improvement.