The cost of smoking in Wales

Background and strategic context

Wales has made substantial progress in tobacco control over recent decades and has a strong policy commitment to achieving a smoke-free Wales by 2030. However, around one in seven adults still smoke, with smoking prevalence remaining significantly higher in more deprived communities. Smoking continues to impose a substantial burden on health services, the economy and the environment in Wales, yet the full cost of smoking is not routinely captured in one place. Existing Welsh evidence on the cost of smoking is outdated and often based on limited methods, reducing its relevance for current policy challenges. At a time of constrained public finances and persistent health inequalities, an up-to-date and comprehensive assessment of the costs of smoking is essential to inform policy, support prevention efforts and guide equitable action across Wales.

This work supports the delivery of Public Health Wales’ Long-Term Strategy and Welsh Government policies, including the ambition of a smoke-free Wales. It provides a detailed breakdown of smoking-related costs across seven key domains: hospital admissions, outpatient attendance, GP services, prescription services, social care, productivity loss and environmental impact. Costs are disaggregated by sex, deprivation quintile and local authority, providing valuable insights into the scale, drivers and distribution of smoking-related harms across Wales, while strengthening the case for early prevention and targeted intervention.

While the analysis focuses on tobacco smoking, further work could also examine the health and economic impacts of e-cigarettes and vaping, which may also cause harm.

Key findings

The overall cost of smoking

• Smoking costs Wales £1.56 billion every year, representing a substantial financial burden across health and social care, productivity and environmental domains.
• The annual cost of smoking amounts to £499 per person, £622 per adult, and £4,661 for every adult who smokes in Wales.
• Smoking-related annual costs were estimated at:
  • £670.0 million for lost productivity
  • £241.2 million for environmental impacts
  • £210.2 million for hospital admissions
  • £196.2 million for social care
  • £94.0 million for prescriptions
  • £78.3 million for outpatient care
  • £71.5 million for GP services
• The £650 million cost of treating and supporting smokers who experience long-term illness and disability represents 5% of Wales’s health and social care budget.
• Smoking results in an estimated 143,264 QALYs lost annually, with the value of these quality-of-life losses estimated at £2.86–£10.03 billion.

Smoking and inequalities

• Smoking prevalence in the most deprived areas (22.6%) is more than three times higher than in the least deprived areas (6.8%), reflecting broader socioeconomic inequalities.
• Nearly one-third of all smoking-related costs (£489.8 million; 31.4%) are concentrated in the most deprived fifth of communities, compared with £169.4 million (10.9%) in the least deprived fifth.
• Inequalities are evident across the deprivation gradient for all cost categories, particularly for productivity losses and social care costs.
• Substantial variation exists between local authorities. Cardiff has the highest total smoking-related costs (£171.4 million), followed by Rhondda Cynon Taf (£163.1 million) and Swansea (£111.7 million). Together, these three areas account for almost 29% of the total cost of smoking in Wales.
• Differences between local authorities reflect variations in smoking prevalence, population structure, deprivation and the wider social determinants of health.
• Males account for a slightly greater share of overall smoking-related costs (£807.6 million; 52%) than females (£753.7 million; 48%), with the largest difference observed in hospital admission costs.
• The economic burden associated with QALY losses falls disproportionately on males and the most deprived communities, where losses are more than three times higher than in the least deprived areas.