Cigarette smoking is the foremost preventable cause of death in the United States. Along with being a major contributor to lung cancer, chronic obstructive pulmonary disease, and cerebrovascular disease, smoking is one of several modifiable risk factors for coronary artery disease (CAD). The Coronary Heart Disease Policy Model is a computer simulation model of CAD in the United States. Using the model, one can project CAD incidence, prevalence, events, mortality, cost, cost-effectiveness, and gains in life expectancy from various risk factor modifications, including smoking interventions. The model projects that reducing the number of cigarettes smoked by 50% would increase the population-wide life expectancy of 35-year-old U.S. citizens by 0.4 year. Eliminating smoking would yield population-wide gains of 0.8 year for 35-year-old males and 0.7 year for 35-year-old females. These gains are comparable to those achieved with strict control of cholesterol levels, diastolic blood pressure, or weight. Gains for the smokers themselves would be much greater. On average, 35-year-old male smokers would live 1.2 years longer if they reduced the number of cigarettes smoked by 50%, and 2.3 years longer if they quit smoking. Females 35 years of age would live 1.5 years longer by cutting back by 50% and 2.8 years longer by quitting. These gains are equal to or greater than gains that individuals would realize by reducing serum cholesterol levels of 240-299 mg/dL to 200 mg/dL; controlling mild hypertension; or reducing weight from ≥130% ideal body weight to ideal body weight. Gains projected by the Coronary Heart Disease Policy Model are comparable to those forecast by others, who have projected that young adults would gain approximately 0.2-8.7 years by quitting smoking, depending on their smoking history. Two studies have examined the cost-effectiveness of smoking interventions. One found that counseling smokers to quit would cost only $705-988 per year of life saved for males and $1,204-2,058 per year of life saved for females. The second study found that prescribing nicotine gum as an adjunct to counseling would cost only $4,113-6,465 per year of life saved for males and $6,880-9,473 per year of life saved for females. These cost-effectiveness ratios are more favorable than those of most other current healthcare interventions. Smoking cessation would increase population-wide life expectancy by about a year and the life expectancy of a smoker by several years. Simple interventions on the part of physicians to get smokers to quit are among the most cost-effective uses of healthcare resources.
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