Tá publicado em tudo quanto eé canto, Luiz. Eu li sobre isso aqui: http://content.nejm.org/cgi/content/full/337/15/1052
"Tudo quanto é canto" é relativo no fim das contas: acesso regularmente o NEJM e não tinha conhecimento do artigo , nem de outros que o tenham citado ( embora ele seja 1997).
Mas ele tem ponto bem controversos quanto à metodologia adotada , admitido inclusive na discussão final:
The results of this study illustrate the ambiguities in any economic method of evaluation. Even a well-designed study of this type is marred by inevitable arbitrariness concerning what costs to include, which discount rate to apply, and what duration of follow-up to use. There are differences of opinion — on the discounting of lifetime costs, for example, and the evaluation of long-term effects.23,24 Recent efforts at standardization will remedy some of the arbitrariness,25,26,27 but fundamental problems with the method still remain.
Isto gerou uma critica de um profissional do CDC em correspondência ao NEJM:
The Health Care Costs of Smoking
To the Editor: The conclusion by Barendregt et al. (Oct. 9 issue)1 that smoking cessation would eventually lead to increased health care costs is questionable because the authors underestimate differences in health care use between smokers and nonsmokers. They attribute to smoking the leading smoking-related diseases, including heart disease, stroke, lung and some other cancers, and chronic obstructive pulmonary disease. According to the Surgeon General's reports, smokers are also at higher risk for a variety of other diseases, including pneumonia and influenza, abdominal aortic aneurysm, gastric and duodenal ulcers, and cataracts. Adding these conditions increases by more than 30 percent the estimate of short-term hospital days for diseases linked to smoking.2
Smokers also have higher utilization rates and expenditures for coexisting diseases not related to smoking. Coexisting disorders increase the resources required to treat many smoking-related conditions; hospital stays are longer, more tests and procedures may be required, and so forth. The authors' report that per capita health care costs are up to 40 percent higher among male smokers and up to 25 percent higher among female smokers, as compared with nonsmokers. However, in the United States, peak differences in costs between smokers and nonsmokers can be more than 100 percent for men and almost 70 percent for women.3 Limiting the calculation of smoking-related costs to the diseases noted in the article omits substantial morbidity and health care utilization and severely underestimates the lifetime medical expenditures associated with smoking.
The authors emphasize the results at lower discount rates that support the conclusion that a nonsmoking population would eventually have higher health care costs. But their sensitivity analysis of the discount rate renders this conclusion ambiguous, since they calculate lower costs for nonsmoking at discount rates of 4.5 percent and higher. Barendregt et al. reject discounting, however, citing differences of opinion on discounting lifetime costs. There is controversy about discounting health effects such as years of life gained, but not about discounting monetary sums. Discounting future monetary values is universally accepted by economists. Furthermore, given the underestimates in the authors' analysis, it is likely that the costs for the nonsmoking population are also lower at the lower discount rates, including the range of 3 to 5 percent generally accepted as most likely to include the social discount rate. Three studies cited by the authors each calculated higher lifetime costs for smokers in the United States. But the authors offer no explanation for the difference between their results and these findings.
Thomas A. Hodgson, Ph.D.
Centers for Disease Control and Prevention
Hyattsville, MD 20782
Estudos posteriores a este acharam resultados divergentes , conforme se lê nos resumos de alguns artigos que citaram este. Portanto não dá para dizer que ele comprova que não-fumantes tem um custo maior que fumantes , já que , além das controvérsia metodológicas , se observou resultados divergentes em outros locais.
Tópico: Eventos coronarianos agudos diminuem na Itália após proibição do fumo (Lida 532 vezes)