The costs of tobacco, alcohol and illicit drug abuse to Australian Society in 2004/05 - Summary Report
Health
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Drug-attributable morbidity imposes health care costs for medical services, hospitals, nursing homes, pharmaceuticals and ambulances. However, the premature deaths caused by drug abuse can relieve the community of some health care cost burdens. If the prematurely deceased were still alive, they would be placing demands on health care resources. The paper estimates these health care savings as well as the health care costs.
Table 5 presents estimates of drug-attributable health care costs and savings. Note that in-patient pharmaceutical costs are incorporated in hospital costs; the pharmaceutical costs identified here refer to prescribed pharmaceuticals outside the hospital system.
Table 5, Health care costs and savings resulting from drug abuse, 2004/05
 | Medical | Hospitals | Nursing | Pharma- | Ambu- | Total |
| | | homes | ceuticals | lances | |
| ($m) | ($m) | ($m) | ($m) | ($m) | ($m) |
Alcohol | | | | | | |
Gross costs | 562.3 | 693.9 | 389.2 | 324.8 | 80.4 | 2,050.5 |
Savings from | 21.5 | 31.6 | (12.0) | 27.2 | 5.5 | 73.9 |
premature | | | | | | |
deaths | | | | | | |
Net costs | 540.7 | 662.2 | 401.2 | 297.6 | 74.8 | 1,976.7 |
Tobacco | | | | | | |
Gross costs | 462.1 | 669.6 | 436.6 | 205.2 | 62.5 | 1,836.0 |
Savings from | 303.7 | 446.2 | 613.9 | 127.9 | 25.9 | 1,517.6 |
premature | | | | | | |
deaths | | | | | | |
Net costs | 158.4 | 223.4 | (177.3) | 77.3 | 36.6 | 318.4 |
Illicit drugs | | | | | | |
Gross costs | 122.5 | 112.6 | 11.9 | n.a. | 6.0 | 252.9 |
Savings from | 17.8 | 26.1 | 5.7 | n.a. | 1.6 | 51.2 |
premature | | | | | | |
deaths | | | | | | |
Net costs | 104.7 | 86.5 | 6.2 | n.a. | 4.4 | 201.7 |
All drugs | | | | | | |
Gross costs | 1,146.8 | 1,476.1 | 837.7 | 530.0 | 148.9 | 4,139.5 |
Savings from | 343.0 | 504.0 | 607.6 | 155.0 | 33.0 | 1,642.7 |
premature | | | | | | |
deaths | | | | | | |
Net costs | 803.8 | 972.1 | 230.1 | 375.0 | 115.8 | 2,496.8 |
n.a. = not available. Numbers in brackets are negative.
Total drug-attributable gross health care costs in 2004/05 were $4.1 billion while net costs were $2.5 billion.
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The study disaggregates the costs of smoking into active and involuntary components. Medical conditions attributable to active smoking occur from smokers inflicting adverse health effects on themselves. Conditions attributable to involuntary smoking occur when smokers inflict adverse health effects on others (including the unborn). Estimates of the impact of involuntary smoking on deaths, hospital bed-days and hospital costs, classified by age, are presented in Table 6.
Table 6, Tobacco-attributable deaths, hospital bed-days and hospital costs, 2004/05, by age and smoking status
| Voluntary | Involuntary | Total |
| Deaths (number) | | | |
| 0–14 | 0.0 | 36 | 36 |
| 15+ | 14,753 | 112 | 14,865 |
| Total | 14,753 | 149 | 14,901 |
| Hospital bed days (number) | | | |
| 0–14 | 0.0 | 61,178 | 61,178 |
| 15+ | 689,951 | 2,489 | 692,440 |
| Total | 689,951 | 63,667 | 753,618 |
| Hospital costs ($m) | | | |
| 0–14 | 0.0 | 30.6 | 30.6 |
| 15+ | 636.0 | 3.1 | 639.1 |
| Total | 636.0 | 33.7 | 669.6 |
The above table clearly illustrates that the costs of involuntary smoking are largely imposed on the young. For children under 15 in 2004/05, involuntary smoking accounted for 25 per cent of deaths, 96 per cent of hospital bed-days and 91 per cent of hospital costs.
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The illicit drug-attributable mortality and morbidity costs as presented in table 6 of the full report relate to illicit drugs as a whole. In reality, ‘illicit drugs’ represents a range of drugs and these costs should, wherever possible, be disaggregated to the level of individual drugs. However, the ability to disaggregate is severely limited by the scope of the available epidemiological data. It is possible to identify some of the effects of individual drugs on mortality, potential years of life lost, hospital usage and gross hospital costs. However, this does not take into account any savings that have resulted from drug-attributable premature deaths. Table 7 summarises these effects.
Table 7, Individual drug categories, summary of health outcomes, 2004/05, persons
| Deaths (number) | PYLL ages 0–74 (number) | Hospital bed days (number) | Gross hospital costs ($’000) |
| Opiates | 228 | 9,417 | 22,463 | 13,094 |
| Cannabis | 1 | 41 | 7,287 | 3,054 |
| Amphetamines | 0 | 0 | 4,710 | 2,618 |
| Cocaine | 0 | 0 | 627 | 412 |
| Psychostimulants | 17 | 806 | 578 | 740 |
| Hallucinogens | 1 | 50 | 418 | 494 |
| Other psychotropics | 3 | 132 | 129 | 192 |
| Anabolic steroids | 0 | 0 | 0 | 0 |
| Other | 139 | 4,561 | 122,683 | 68,998 |
| Licit/unspecified/combined | 483 | 16,498 | 40,811 | 22,961 |
| Total | 872 | 31,504 | 199,706 | 112,563 |
| Sum of identified drugs | 250 | 10,445 | 36,212 | 20,604 |
PYLL = potential years of life lost.
As Table 7 shows, a significant proportion of the total impact on mortality and morbidity results from unspecified drugs. Only 28.7 per cent of total illicit drug-attributable deaths can be assigned to specific drugs, 33.2 per cent of potential years of life lost, 18.1 per cent of hospital bed-days and 18.3 per cent of gross hospital costs.
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