Introduction:
Tobacco-related diseases have a substantial economic impact in terms of medical expenses, productivity loss, and premature death. Each year, tobacco use is estimated to be responsible for over 90,000 deaths in Italy, where the prevalence of current smokers was 24.2% in 2022. This prevalence grew over the last few years, after seven decades of decreasing trend. We aim to evaluate the annual direct economic impact attributable to tobacco smoking in Italy, using ministerial data of all the hospital discharges from 14 selected tobacco-related diseases.

Material and Methods:
We analyzed data from smoking-related hospitalizations in Italy in 2018. Information was retrieved from 1.001.424 hospital discharge reports, which included the direct cost of each hospitalization. We computed the Population Attributable Fractions (PAF) for each tobacco-related disease to estimate the economic impact attributable to tobacco smoking.

Results:
Of all the hospitalizations for tobacco-related diseases, one-third were found to be attributable to smoking, accounting for €1.67 billion. Among the considered diseases, those with the highest expenditure attributable to smoking were ischemic heart diseases, cerebrovascular diseases, and lung cancer, accounting for €556, €290, and €229 million, respectively.

Conclusions:
Tobacco-related diseases have a substantial economic impact in Italy, accounting for 5.88% of the total cost of hospitalizations in 2018. We limited the analyses to hospitalizations, which represent less than one fourth of the total cost of the Italian National Health System. The increase of smoking prevalence in Italy is alarming, and it is therefore essential to implement effective tobacco control measures to decrease the number of hospitalizations and deaths attributable to smoking and the corresponding economic burden.