Economic costs of diseases and deaths attributable to bidi smoking in India, 2017.

OBJECTIVE: To estimate the economic burden of diseases and deaths attributable to bidi smoking in India for persons aged 30-69 years.
METHODS: The National Sample Survey data on healthcare expenditures, data on bidi smoking prevalence from the Global Adult Tobacco Survey and relative risks of all-cause mortality from bidi smoking are used to estimate the economic burden of diseases and deaths attributable to bidi smoking in India using a prevalence-based attributable-risk approach. Costs are estimated under the following heads: (1) direct medical expenditure of treating diseases; (2) indirect morbidity costs and (3) indirect mortality costs of premature deaths.
FINDINGS: The total economic costs attributable to bidi smoking from all diseases and deaths in India in the year 2017 for persons aged 30-69 years amount to INR805.5 billion (US$12.4 billion), of which 20.9% is direct and 79.1% is indirect cost. Men bear 93.7% of the total costs.
CONCLUSION: The total annual economic costs of bidi smoking amount to approximately 0.5% of India's gross domestic product, while the excise tax revenue from bidi is only half a per cent of its economic costs. The direct medical costs of bidi smoking amount to 2.24% of total health expenditure. Since the poor bear a disproportionately large share of the economic costs of bidi smoking, the unregulated use of bidi would potentially push more households in India, which incur heavy out-of-pocket expenditures on healthcare, into poverty. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.