Brief notes on the new 2014 ASH Ready
Reckoner – understanding the domains
and how they were calculated
For each location selected in the ASH Ready Reckoner tool the total cost that is presented is
composed of 7 different domains, with an 8th figure associated with the volume of discarded
cigarette butts. Each domain is briefly explained below with some basic guidance on the methods
used to derive the figures.
Please note that, in each case, the figures provided by the tool are estimates only and should be
used as guidelines when considering the local cost of tobacco to society. While every effort has been
made to use the best available data, in some cases values have either been directly synthesised or
are estimates derived from synthetic values. In all such cases, great care has been taken to ensure
that the values are representative of wider estimates; syntheses have only been used where no
directly empirical data were available.
Contents
Costs of lost productivity ........................................................................................................................ 2
Due to early smoking-related deaths.................................................................................................. 2
Due to smoking breaks ....................................................................................................................... 2
Due to smoking-related sick days ....................................................................................................... 3
Costs to NHS............................................................................................................................................ 3
Direct costs of treating smoking-related illnesses .............................................................................. 3
Costs of healthcare events caused by passive smoking ..................................................................... 3
Social care costs ...................................................................................................................................... 3
Costs of smoking-attributable fires......................................................................................................... 4
Extent of smoking-related litter (cigarette butts) ................................................................................... 4
Tobacco duty contributions .................................................................................................................... 4
Ward-level data....................................................................................................................................... 4
Costs of lost productivity
Due to early smoking-related deaths
The cost associated with lost productivity due to early smoking-related deaths is probably the most
complex value estimated in the Ready Reckoner itself (as opposed to figures derived from
calculations performed elsewhere, for which full methodologies are available separately). An
overview of the methodology is briefly described below, divided into steps:
1. The Local Tobacco Control Profiles provide data estimating the rate of smoking-attributable
mortality across local populations of adults aged 35 and over. This is used in combination
with local population estimates to derive an overall estimated number of smoking-related
deaths at a given locality.
2. Average regional figures for the rate of employment among smokers are derived from the
Integrated Household Survey and used to estimate what proportion of these smokingattributable deaths occur in employed individuals, giving the estimated number of employed
adults dying annually as a result of smoking-related diseases. (In the absence of better data,
the employment rate among smokers is assumed to be static across ages and the mortality
rate to be distributed evenly across employment status.)
3. In addition to this, there is an average mortality risk associated with each year-age subgroup
of the population. Due to the range of diseases and other risk factors that are associated
with smoking, on average smokers and ex-smokers are expected to have differentially higher
mortality rates (at ages 35 and over) than never smokers of the same age. Similarly, because
males and females have different smoking habits and life expectancies, different mortality
rates are associated with men and women. For each year-age-gender subgroup in the
population, this difference can be calculated as the relative risk associated with being either
a current smoker (male vs female) or an ex-smoker (male vs female). This year-age-gender
relative risk is then used to estimate how all the smoking-related deaths among those in
employment are distributed across the 35+ population of male and female current smokers
and ex-smokers. This produces age- and gender-specific estimates of the number of deaths
attributable to smoking each year at a given location.
4. Finally, each age-gender subgroup has an associated average number of years’ productivity,
e.g. a 35 year old male has 30 full years of productivity ahead before reaching retirement
age, thus 30yrs productivity. So, the total number of smoking-related deaths in men aged 35
can be multiplied by 30 to give a total number of years of productivity lost due to men of
that age group dying from smoking-related illness; likewise, for women aged 35 (each losing
25 years of productivity). In this way, the total number of lost male and female productivity
years can be estimated and in turn be multiplied by the relevant average gender- and
region-specific salary, giving the total local cost of lost productivity due to early deaths from
smoking.
Due to smoking breaks
The cost of lost productivity due to smoking breaks is derived directly from the British Heart
Foundation report “The Cost of Smoking to UK Businesses”: the estimated employment rate among
smokers is used to calculate the local number of smokers in work, which is then divided between
full-time and part-time workers according to local figures from the annual survey of hours and
earnings (proportions used are for the whole population and are assumed to be the same for
smokers and non-smokers). The relevant average annual costs associated with time lost to smoking
breaks as cited in the BHF report are then applied to the full-time and part-time employed smokers
population locally to generate a total cost figure. Regional variations in wage rate are not captured in
this analysis.
Due to smoking-related sick days
The cost of lost productivity due to smoking-related sick days is derived directly from the NICE ROI
tool for Tobacco Control, using the default values for each locality: in the ROI tool, current smoking
prevalence is applied to the current adult population of the selected locality and the regional
employment rate among smokers to determine the total number of local employed smokers. Based
on evidence cited in the NICE tool, it is assumed that smokers suffer on average 2.74 days of
additional sickness absence from work compared with non-smokers. Thus the total number of
employed smokers is multiplied by this factor and a regional average daily wage rate to produce the
total cost of lost working days attributable to smoking-related illness.
Costs to NHS
Direct costs of treating smoking-related illnesses
The cost to the NHS of smoking-related illnesses is derived directly from the NICE ROI tool for
Tobacco Control, using the default values for each locality: in the ROI tool, the number of smokers at
the selected locality is used in combination with the relative risk of developing various smokingrelated illnesses to estimate the local smoking-related disease profile. This is used with national
averages to estimate the overall number of healthcare events relating to this disease profile (GP
visits, practice nurse visits, hospital admissions, outpatient visits and prescriptions); a cost is
associated with each event type and these costs are aggregated to give the total cost of treating
directly smoking-related illnesses.
Costs of healthcare events caused by passive smoking
The cost of passive smoking-related illnesses is derived directly from the NICE ROI tool for Tobacco
Control, using the default values for each locality: in the ROI tool, the number of smokers at the
selected locality is used in combination with estimates of the rates of exposure to secondhand
smoke (SHS) among adults and children to produce figures for the local number of passive smokers.
Relative risks in non-smokers of suffering healthcare events associated with exposure to SHS are
then used to estimate the number of cases of such healthcare events in adults and children
separately. A cost is associated with each event type and these costs are aggregated to give the total
cost of treating passive smoking-related illnesses.
Social care costs
The cost of caring for individuals suffering from smoking-related illnesses in later life is derived
directly from the ASH report “The Costs of Smoking to the Social Care System and Society in
England”: the total costs across England (those met by local governments and those met by
individuals) were proportionately divided across local authorities according to the synthesised 50+
smoking population.
Costs of smoking-attributable fires
National fire statistics are available at a Fire Service level and variously provide figures for the
number of fires according to ignition source and setting and the total number of fire casualties
(deaths and injuries); additionally, all fire casualties are reported at a national level, stratified by
ignition source. These figures were used to derive an average number of smoking-related fires, an
average number of deaths due to smoking-related fires and an average number of non-fatal
casualties as a result of smoking-related fires for each fire service footprint. (Smoking-related fires
are those reported as being either caused by “smokers’ materials” or by “cigarette lighters”.)
Government figures from a 2006 white paper estimate the wider societal costs associated with the
various consequences of fires, including deaths, injuries and other non-human costs – these values
are applied to the relevant estimates to produce an overall figure for the total cost of smokingrelated fires at a fire service level. This total cost is factored as a cost per smoking household and this
is then used to disaggregate the overall costs across the local authorities being served by the fire
service.
Extent of smoking-related litter (cigarette butts)
The scale of smoking-related litter cited in the tool is restricted to the contribution of discarded
cigarette butts containing filters, which are almost exclusively non-biodegradable. Synthetic
estimates of the smoking prevalence across different socio-economic groups at each locality are
used to generate estimates of the number of smokers across the 8 different NS-SEC categories.
These smoking populations are then combined with NS-SEC-specific estimates of daily cigarette
consumption to give a total number of cigarettes smoked annually. National trends are used to
divide this total figure between cigarettes smoked by males and females and this is in turn further
divided between pre-rolled cigarettes and hand-rolled tobacco (HRT) using data from the General
Lifestyle Survey. Based on national estimates, the figure for HRT cigarettes is restricted to those
where filters are used (approximately 1 in 3), thus giving a total estimate for the number of filtered
cigarettes (hand-rolled and pre-rolled) smoked annually. All filtered cigarette butts must be disposed
of as waste. However, national estimates from Keep Britain Tidy place the rate of habitual street
littering among smokers at a minimum of 23% and this value was used to estimate the quantity of
filters needing to be cleared by local street-sweeping services. The total tonnage is based on a perfilter mass of 0.1701g.
Tobacco duty contributions
National HMRC taxation figures for England are used to derive duty paid on tobacco; because duty is
variable (dependent upon a range of factors including unit size purchased and cigarette length),
direct estimates of the local contribution cannot be calculated. As such, the England figure is
expressed as a per-smoker contribution, which is then aggregated according to the estimated local
smoking population size.
Ward-level data
Direct estimates of smoking prevalence at a ward level are not possible due to the small sizes of the
populations. However, synthetic estimates have been produced based upon the socio-economic
makeup of a ward and the smoking prevalence of the local authority in which each ward sits. For
each LA, the various cost domains in the tool are expressed as a per-smoker cost and this is then
applied to the synthetic ward-level smoking population. Thus, the costs cited for the wards are very
broad estimates but do ultimately correctly aggregate back up to the LA-level from which they are
derived.