Disease burden from tobacco consumption in Peru and the projected effect of strengthening control measures: a modeling study
DOI:
https://doi.org/10.17843/rpmesp.2025.422.14338Keywords:
Tobacco use, Tobacco Control, Cost of illness, PeruAbstract
Objectives. To estimate the economic burden and disease burden associated with tobacco use in Peru and the projected effect of strengthening specific tobacco control measures. Materials and methods. We used a Markov microsimulation model to assess smoking-attributable mortality, disease events, economic costs, and projected benefits over ten years, considering the implementation of measures such as plain packaging, full enforcement of smoke-free laws, a complete ban on tobacco advertising, promotion, and sponsorship, and increased cigarette taxes. Results. Each year in Peru, approximately 22,350 deaths and 126,000 disease events are attributable to tobacco use, accounting for 19% of all deaths from heart disease, 18% of deaths from stroke, and 515,768 years of life lost. In addition, approximately
1.28% of gross domestic product is lost annually due to smoking. Over ten years, the implementation of plain packaging could prevent 6,218 deaths, 31,700 events, and save 576 million USD. Full compliance with smoke-free places would prevent 4,982 deaths, 25,400 events, and save 461 million USD. Banning advertising, promotion, and sponsorship could prevent 8,767 deaths, 44,700 events, and save 812 million USD. Increasing cigarette prices by 50% could prevent 20,400 deaths, 658,400 healthy life years lost, and an economic benefit of more than 3.3 billion USD. Conclusions. The economic and disease burden of tobacco use in Peru is significant. Greater efforts to control tobacco would significantly reduce this burden.
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References
Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries
and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet [Internet]. 2020;396(10258):1223–49. doi: 10.1016/S0140-6736(20)30752-2.
World Health Organization (WHO). WHO Framework Convention on Tobacco Control [Internet]. World Health Organization (WHO). [citado el 29 de mayo de 2024]. Disponible en: https://fctc.who.int/
World Health Organization (WHO). WHO global report on trends in prevalence of tobacco use 2000–2030 [Internet]. World Health Organization (WHO); 2024 [citado el 29 de mayo de 2024]. Disponible en: https://www.who.int/publications/i/item/9789240088283.
Goodchild M, Nargis N, Tursan d’Espaignet E. Global economic cost of smoking-attributable diseases. Tob Control [Internet]. 2018;27(1):58–64. doi: 10.1136/tobaccocontrol-2016-053305.
OPS. Informe sobre el control del tabaco en la Región de las Américas 2022 [Internet]. OPS; 2022. Disponible en: https://iris.paho.org/bitstream/handle/10665.2/56263/OPSNMHRF220023_spa.pdf.
GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet [Internet]. 2021;397(10292):2337–60. doi: 10.1016/S0140-6736(21)01169-7.
Pichon-Riviere A, Alcaraz A, Palacios A, Rodríguez B, Reynales-Shigematsu LM, Pinto M, et al. The health and economic burden of smoking in 12 Latin American countries and the potential effect of increasing tobacco taxes: an economic modelling study. Lancet Glob Health [Internet]. 2020;8(10):e1282–94. doi: 10.1016/S2214-109X(20)30311-9.
Pan American Health Organization (PAHO). Report on Tobacco Control for the Region of the Americas 2022 [Internet]. PAHO; 2022 [citado el 29 de mayo de 2024]. doi: 10.37774/9789275125892.
Bardach AE, Caporale JE, Alcaraz A, Augustovski F, Huayanay-Falconí L, Loza-Munarriz C, et al. Carga de enfermedad por tabaquismo e
impacto potencial del incremento de precios de cigarrillos en el Perú. Rev Peru Med Exp Salud Publica [Internet]. 2016;33(4):651–61. doi:
17843/rpmesp.2016.334.2548
Pichon-Riviere A, Bardach A, Rodríguez Cairoli F, Casarini A, Espinola N, Perelli L, et al. Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study. Tob Control [Internet]. 2024;33:611–21. doi: 10.1136/tc-2022-057618.
Congreso de la República. Poder Legislativo Congreso de la República - Ley 28705. El Peruano [Internet]. 2006; Disponible en: http://www.digesa.minsa.gob.pe/norma_consulta/Ley_28705.pdf.
Congreso de la República. Poder Legislativo Congreso de la República - Ley 29517. El Peruano [Internet]. 2010; Disponible en: http://www.digesa.minsa.gob.pe/norma_consulta/Ley_29517.pdf.
World Health Organization (WHO). WHO report on the global tobacco epidemic, 2023: protect people from tobacco smoke [Internet]. World Health Organization (WHO). World Health Organization; 2023 [citado el
de mayo de 2024]. Disponible en: https://www.who.int/publications/i/item/9789240077164.
Bernabé-Ortiz A, Carrillo-Larco RM. Prevalencia y tendencias de tabaquismo activo y pasivo en adolescentes peruanos. Rev Peru Med
Exp Salud Publica [Internet]. 2022;39(2):193–200. doi: 10.17843/rpmesp. 2022.392.11233.
Mallma P, Carcamo C, Kaufman JS. The impact of anti-tobacco legislation on birth weight in Peru. Glob Health Res Policy [Internet]. 2020;5(1):5. doi: 10.1186/s41256-020-00136-5.
Hunink M, Weinstein MC, Wittenberg E, Drummond MF, Pliskin JS, Wong JB, et al. Decision making in health and medicine: Integrating evidence and values [Internet]. 2a ed. Cambridge, England: Cambridge University Press; 2014 [citado el 26 de marzo de 2025]. 446 p. doi: 10.1017/cbo9781139506779.
Briggs A, Sculpher M, Claxton K. Modelling Methods for Health Economic Evaluation. New York, NY: Oxford University Press; 2006.
Palacios A, Alcaraz A, Casarini A, Rodriguez Cairoli F, Espinola N, Balan D, et al. The health, economic and social burden of smoking in Argentina, and the impact of increasing tobacco taxes in a context of illicit trade. Health Econ [Internet]. 2023;32(11):2655–72. doi: 10.1002/hec.4741.
Bardach A, Cañete F, Sequera VG, Palacios A, Alcaraz A, Rodríguez B, et al. Carga de enfermedad atribuible al uso del tabaco en Paraguay y potencial impacto sanitario y económico del aumento del precio a través de impuestos. Rev Peru Med Exp Salud Publica [Internet]. 2018;35(4):599–609. doi: 10.17843/rpmesp.2018.354.3708.
Pinto M, Bardach A, Palacios A, Biz A, Alcaraz A, Rodriguez B, et al. Burden of smoking in Brazil and potential benefit of increasing taxes on cigarettes for the economy and for reducing morbidity and mortality. Cad Saude Publica [Internet]. 2019 [citado el 17 de julio de 2024];35(8):e00129118. doi: 10.1590/0102-311X00129118.
Bardach A, Casarini A, Rodriguez Cairoli F, Adeniran A, Castradori M, Akanonu P, et al. The estimated benefits of increasing cigarette
prices through taxation on the burden of disease and economic burden of smoking in Nigeria: A modeling study. PLoS One [Internet].
;17(3):e0264757. doi: 10.1371/journal.pone.0264757.
Pichon-Riviere A, Augustovski F, Bardach A, Colantonio L, Latinclen Tobacco Research Group. Development and validation of a microsimulation economic model to evaluate the disease burden associated with smoking and the cost-effectiveness of tobacco control interventions in Latin America. Value Health [Internet]. 2011;14(5 Suppl 1):S51–9. doi: 10.1016/j.jval.2011.05.010.
Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004. JAMA [Internet]. 2009;301(6):593. doi: 10.1001/jama.301.6.593.
Ministerio de Salud de Perú. Información de Fallecidos del Sistema Informático Nacional de Defunciones - SINADEF [Internet]. SINADEF. [citado 2022]. Disponible en: https://www.datosabiertos.gob.pe/dataset/información-defallecidos-del-sistema-informático-nacional-de-defunciones-sinadef-ministerio.
Jørgensen T, Johansen C, Jensen G, Møller H, Møller S, Pedersen N, et al. Det danske MONICA-projekt. Resultater, erfaringer og perspektiver. Ugeskr Laeger. 1999;161(44):6089–95.
Thorvaldsen P, Kuulasmaa K, Rajakangas AM, Rastenyte D, Sarti C, Wilhelmsen L. Stroke trends in the WHO MONICA project. Stroke
[Internet]. 1997 [citado el 6 de mayo de 2025];28(3):500–6. doi: 10.1161/01.str.28.3.500.
Caccavo A, Álvarez A, Bello FH, Ferrari AE, Carrique AM, Lasdica S, et al. Incidencia poblacional del infarto con elevación del ST o bloqueo de rama izquierda a lo largo de 11 años en una comunidad de la provincia de Buenos Aires. Rev Argent Cardiol [Internet]. 2007 [citado el 6 de mayo de 2025];75(3):185–8. Disponible en: https://www.scielo.org.ar/scielo.php?script=sci_abstract&pid=S1850-37482007000300006&lng=es&nrm=iso&tlng=pt.
Menezes AMB, Perez-Padilla R, Jardim JRB, Muiño A, Lopez MV, Valdivia G, et al. Chronic obstructive pulmonary disease in five Latin
American cities (the PLATINO study): a prevalence study. Lancet [Internet]. 2005 [citado el 6 de mayo de 2025];366(9500):1875–81.
doi: 10.1016/S0140-6736(05)67632-5.
Tuomilehto J, Bonita R, Stewart AW, Nissinen A, Salonen JT. Disparities in stroke mortality trends between eastern and western European MONICA populations. Stroke. 1991;22(12):1518–25.
Malyutina S, Bobak M, Kurilovitch S, Gafarov V, Simonova G, Nikitin Y, et al. Relation between heavy and binge drinking and all-cause and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study. Lancet [Internet]. 2002 [citado el 6 de mayo de 2025];360(9344):1448–54. doi: 10.1016/S0140-6736(02)11470-X.
Rastenyte D, Tuomilehto J, Sarti C. Increasing trends in stroke mortality in Kaunas, Lithuania, between 1986 and 1995: the MONICA stroke register. Cerebrovasc Dis. 1998;8(4):210–7.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin [Internet]. 2021 [citado el 6 de mayo de 2025];71(3):209–49. doi: 10.3322/caac.21660.
Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ [Internet]. 2004 [citado el 6 de mayo de 2025];328(7455):1519. doi: 10.1136/bmj.38142.554479.AE.
BANCO CENTRAL DE RESERVA DEL PERÚ. Gerencia Central de Estudios Económicos. BCRPData. Dólar Americano (US$) [Internet]. 2020 [citado enero de 2025]. Disponible en: https://estadisticas.bcrp.gob.pe/estadisticas/series/mensuales/resultados/PN01234PM/html/2020-1/2020-1/.
Lev B, Schwartz A. On the Use of the Economic Concept of Human Capital in Financial Statements. Account Rev [Internet]. 1971;46(1):103–12. Disponible en: http://www.jstor.org/stable/243891.
Lemieux T. The “Mincer Equation” Thirty Years After Schooling, Experience, and Earnings. En: Grossbard S, editor. Jacob Mincer A Pioneer of Modern Labor Economics [Internet]. Boston, MA: Springer US; 2006. p. 127–45. doi: 10.1007/0-387-29175-X_11.
Harberger AC, Guillermo-Peón S. Estimating private returns to education in Mexico. Lat Am J Econ [Internet]. 2012 [citado el 18 de julio de 2024];49(1):1–35. doi: 10.4067/S0719-04332012000100001.
INEI. Instituto Nacional de Estadística e Informática [Internet]. Encuesta Nacional de Hogares (ENAHO) 2020. 2020 [citado el 18 de julio de 2022]. Disponible en: https://datosabiertos.gob.pe/dataset/encuesta-nacional-de-hogares-enaho-2020-instituto-nacional-de-estad%C3%ADstica-e-inform%C3%A1tica-inei.
Krol M, Brouwer W, Rutten F. Productivity costs in economic evaluations: past, present, future. Pharmacoeconomics [Internet]. 2013;31(7):537–49. doi: 10.1007/s40273-013-0056-3.
Knies S, Severens JL, Ament AJ, Evers SM. The transferability of valuing lost productivity across jurisdictions. Differences between national pharmacoeconomic guidelines. Value Health [Internet]. 2010;13(5):519–27. doi: 10.1111/j.1524-4733.2010.00699.x.
Krol M, Brouwer W. How to estimate productivity costs in economic evaluations. Pharmacoeconomics [Internet]. 2014;32(4):335–44. doi: 10.1007/s40273-014-0132-3.
Espinola N, Pichon-Riviere A, Casarini A, Alcaraz A, Bardach A, Williams C, et al. Making visible the cost of informal caregivers’ time in Latin America: a case study for major cardiovascular, cancer and respiratory diseases in eight countries. BMC Public Health [Internet]. 2023;23(1):28. doi: 10.1186/s12889-022-14835-w.
Levy DT, Ellis JA, Mays D, Huang A-T. Smoking-related deaths averted due to three years of policy progress. Bull World Health Organ [Internet]. 2013;91(7):509–18. doi: 10.2471/BLT.12.113878.
Pierce JP, Messer K, White MM, Cowling DW, Thomas DP. Prevalence of heavy smoking in California and the United States, 1965-2007. JAMA [Internet]. 2011;305(11):1106–12. doi: 10.1001/jama.2011.334.
Chaluoupka F, Hu T, Warner K, Jacobs R, Yurekli A. The taxation of tobacco products. En: Tobacco control policies in developing countries [Internet]. Oxford University Press; 2000. Disponible en: https://pure.york.ac.uk/portal/en/publications/the-taxation-of-tobacco-products.
Safiri S, Carson-Chahhoud K, Noori M, Nejadghaderi SA, Sullman MJM, Ahmadian Heris J, et al. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. BMJ [Internet]. 2022;378:e069679. doi: 10.1136/bmj-2021-069679.
Chen X, Mo S, Yi B. The spatiotemporal dynamics of lung cancer: 30-year trends of epidemiology across 204 countries and territories. BMC Public Health [Internet]. 2022;22(1):987. doi: 10.1186/s12889-022-13281-y.
Jaganath D, Miranda JJ, Gilman RH, Wise RA, Diette GB, Miele CH, et al. Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru. Respir Res [Internet]. 2015;16(1):40. doi: 10.1186/s12931-015-0198-2.
OECD. “Informal carers”, in Health at a Glance 2019: OECD Indicators [Internet]. OECD Publishing, editor. OECD Publishing; 2019. doi:
1787/a80d9f62-en.
Bardach A, Alcaraz A, Roberti J, Ciapponi A, Augustovski F, Pichon-Riviere A. Optimizing Tobacco Advertising Bans in Seven Latin American Countries: Microsimulation Modeling of Health and Financial Impact to Inform Evidence-Based Policy. Int J Environ Res Public Health [Internet]. 2021;18(10). doi: 10.3390/ijerph18105078.
Savedoff WD, Alwang A. The single best health policy in the world: Tobacco taxes [Internet]. Center for Global Development; 2015. Disponible en: https://www.cgdev.org/sites/default/files/CGD-Policy-Paper-62-Savedoff-Alwang-Best-Health-Policy-Tobacco-Tax.pdf.
Ministerio de Economía y Finanzas del Peru. Actualizan montos fijos vigentes aplicables a bienes sujetos al Sistema Específico del Impuesto Selectivo al Consumo [Internet]. Ministerio de Economía y Finanzas del Peru; 2024. Disponible en: https://cdn.www.gob.pe/uploads/document/file/5782614/5135469-rm030_2024ef15.pdf?v=1706668736.
Hernández-Vásquez A, Visconti-Lopez FJ, Vargas-Fernández R. Analysis of tobacco consumption, before and during the COVID-19 pandemic in Peru. Tob Induc Dis [Internet]. 2022;20:48. doi: 10.18332/tid/149905.
Barreto IB, Marchan HAS, Sánchez RMS. Consecuencias económicas y sociales de la inamovilidad humana bajo COVID-19: caso de estudio Perú. Lect Econ [Internet]. 2021 [citado el 23 de mayo de 2025];(94):285–303. Disponible en: https://www.redalyc.org/journal/1552/155266647009/html/.
Flor LS, Reitsma MB, Gupta V, Ng M, Gakidou E. The effects of tobacco control policies on global smoking prevalence. Nat Med [Internet]. 2021;27(2):239–43. doi: 10.1038/s41591-020-01210-8.
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Copyright (c) 2025 Ariel Bardach, Andrea Alcaraz, Jhonatan R. Mejia, Natalia Espinola, Elena Lazo, Federico Cairoli, Alfredo Palacios, Lucas Perelli, Federico Augustovski, Cesar Loza-Munarriz, Agustin Casarini, Andrés Pichon-Riviere

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