Although smokers have more diseases and make greater demands on the health service while they are alive, non-smokers live longer and cost more to treat when they are old. It is cheaper for the health service if people die young than if they live to a great age.
The study by researchers from Erasmus University in the Netherlands, found that health care costs at a given age are as much as 40 per cent higher for smokers than for non-smokers. If all smokers quit, health care costs would be lower at first but after 15 years they would become higher than at present.
Life expectancy at birth for smokers is 69.7 for men and 75.6 for women but for non-smokers they are 77 for men and 81.6 for women. At age 70, 78 per cent of male non-smokers are still alive compared with 57 per cent of smokers. At age 80, the comparable figures are 50 per cent and 21 per cent.
The prospect of paying all those extra health costs and pensions may account for the reluctance of governments around the world to take firmer action against smoking.
Lifetime health costs were calculated at $72,700 (pounds 45,000) among men who smoke and $94,700 among women, compared with $83,400 among men who do not smoke and $111,000 among women.
Writing in the New England Journal of Medicine the authors conclude: "In formulating public health policy, whether or not smokers impose a net financial burden ought to be of very limited importance. Public health policy should be concerned with health. Smoking is a major health hazard...[and] should be discouraged."