The Health and Economic Consequences of Smoking and Smoking Cessation Interventions: The Dutch Perspective

  • M. P. M. H. Rutten-van Mölken
  • T. Feenstra
Reference work entry


Cigarette smoking causes a high health burden worldwide. This paper reviews trends in cigarette use, the health and economic consequences of smoking, and the cost-effectiveness of smoking cessation interventions ( cost-effectiveness analysis) from a Dutch perspective. The Netherlands are in the third phase of the smoking epidemic, but  smoking prevalence is still around 28% in adults. The country ranks in the middle of European countries with respect to the implementation of tobacco control policies.

It has been estimated that about 20% of all life years lost, 7% of all disease-year equivalents, 13% of all Disability Adjusted Life Years (DALYs), and 4% of total health care costs in the Dutch population is attributable to smoking. This is far more than the burden attributable to other single risk factors. The overall  life expectancy of a male smoker is 7.7 years less than the life expectancy of a male non-smoker. Hence, there is a lot to be gained from the prevention of smoking. Due to the severely reduced life expectancy, lifetime health care costs are lower in smokers than in never smokers.

Nevertheless, strong evidence exists that individual smoking cessation interventions consisting of counseling with or without pharmacotherapy are cost-effective. Collective policy measures like tobacco tax increases and mass media campaigns are probably even more efficient. In The Netherlands, structured stop advice by the general practitioner was found to be cost saving, looking at intervention costs net of savings from a reduced incidence of smoking related diseases. When health care costs for diseases not related to smoking that occur during the life years gained by smoking cessation are included, the cost-effectiveness worsens, but the ratios remain below €20,000 per  Quality Adjusted Life Year (QALY). Despite this evidence, few smokers receive cessation aid and most try to stop without any professional support. Reimbursement of smoking cessation interventions might stimulate their use and indications were found that reimbursement might be cost-effective.

To conclude, smoking prevention will result in large health gains, but not in cost savings. Smoking cessation can realize a substantial health gain, even if quit rates are at most 20% and 75% of quitters relapses. Even when accounting for additional costs in life years gained, many smoking prevention and smoking cessation policy interventions are cost-effective with ratios ranging from a few thousand up to €20,000 per QALY.


Chronic Obstructive Pulmonary Disease Smoking Cessation Nicotine Replacement Therapy Smoking Prevalence Quality Adjust Life Year 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:




chronic obstructive pulmonary disease


cardiovascular disease


disability adjusted life years


European Union


framework convention on tobacco control


general practitioner


 health adjusted life expectancy


minimal intervention strategy by the general practitioner or his assistant (Huisartsen-Minimale Interventie Strategy)


intensive counseling


life expectancy


mass media campaign


nicotine replacement therapy


odds ratio


 population attributable risk


quality adjusted life years


National Institute for Public Health and the Environment (RijksInstituut voor Volksgezondheid en Milieuhygiene)


Dutch Foundation for a Smokeless Future


telephone counseling


World Health Organization


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Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • M. P. M. H. Rutten-van Mölken
    • 1
  • T. Feenstra
    • 2
  1. 1.Institute for Medical Technology AssessmentErasmus MCThe Netherlands
  2. 2.Netherlands Institute for Public Health and the EnvironmentBilthovenThe Netherlands

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