Helyer et al. (1998) estimated the direct health-care costs for prevention, diagnosis of, and treatment for tobacco-related diseases in US military personnel in 1995 to be $584 million—mostly for hospitalization (77%) and physician fees (18%). Over 9,200 hospital-bed days for active-duty personnel were attributed to tobacco-related diseases, or about 10% of the total DoD hospital-bed days and 1.5% of all active-duty hospital-bed days (Helyer et al., 1998). Tobacco-related medical costs amounted to $20 million in a 1997 CDC study of smoking in active-duty Air Force personnel, or 6% of total Air Force medical-system expenditures (CDC, 2000); the study was based on a health-assessment survey of 5,164 active-duty Air Force TRICARE Prime enrollees who were 17–64 years old in 1997, and about 26% of the men and 27% of the women smoked.
In 2006, about 4.3 million people were enrolled in the DoD Military Health System TRICARE Prime program (active-duty personnel and their dependents as well as military retirees under 65 years old and their dependents). The annual cost of health care for those enrollees is $12.8 billion. Dall et al. (2007) conducted a financial analysis to determine the costs to TRICARE Prime for treating health problems associated with being overweight and obese, with high alcohol consumption, and with tobacco use in this population. About 1.4 million (47%) of all TRICARE Prime adult enrollees (17–64 years old) were current or former smokers, 19% were former smokers (no cigarettes in the preceding 30 days and at least 100 cigarettes in their lifetime), 17% were light smokers (1–14 cigarettes/day), 7% were moderate smokers (15–24 cigarettes/day), and 3% were heavy smokers (at least 25 cigarettes/day). An estimated 179,000 enrollees (mostly young men) were smokeless tobacco users; the prevalence of pipe and cigar smokers was low. The annual medical cost to TRICARE Prime to treat comorbidities associated with tobacco use was $564 million or 4% of the total expenditures; the greatest expenditures were due to 61,367 cases of cardiovascular disease ($255 million) and 94,419 cases of respiratory problems ($150 million). Other major costs were associated with 4,808 cases of cancer ($81 million), 11,686 cases of cerebrovascular disease ($72 million), and 150 cases of newborn health conditions ($2 million). In 2006, direct treatment for tobacco use amounted to $4.3 million for 18,869 tobacco users, or about $228 per tobacco user per year. When the costs of treating all medical conditions associated with tobacco use were averaged, retirees and dependents incurred greater medical costs due to tobacco use ($321) than did active-duty enrollees ($104) or their dependents ($106). However, the total average for active-duty personnel