In Spain, a pack of cigarettes costs between $4.20 and $5.60. But factor in the cost of a premature death – a cost borne solely by the smoker – and the price tag for a pack rises to $150 for men and $105 for women.

The researchers behind this calculation say that understanding the true cost will help prevent smoking. While the numbers may differ, the Spanish results should speak to smokers around the world, including in the United States. [Infographic: Who Still Smokes?]

"Given that tobacco consumption raises the risk of death in comparison with nonsmokers, it can be assigned a premature death cost for people who do smoke," said study researcher Ángel López Nicolás, of the Polytechnic University of Cartagena in Spain. Smoking shaves an average of 7.13 years off the life expectancy of a man and 4.5 years for a woman, according to Nicolás

Their calculation relies on the Value of a Statistical Life (VSL). As an estimate of the tradeoff between monetary cost and safety, VSL can be used to describe the amount a person, or government, is willing to spend to reduce the cost of death.

Nicolás and his colleagues combined the VSL for Spanish smokers with epidemiological data on life expectancies for smokers and nonsmokers, as well as data on tobacco consumption, to arrive at the per-pack estimate. Health-care costs were not included.

"The mortality cost per pack of cigarettes is highly above its market price," they wrote in the May-June issue of the journal Revista Española de Salud Pública.

In the United States, the "true cost" of a pack has been a popular calculation in recent years, yielding a variety of results.

A study published in the Journal of Health Economics, which also employed the VSL, found a mortality cost as high as $222 per pack for men in 2006 dollars. Meanwhile, in "The Price of Smoking" (The MIT Press, December 2004), Duke University researchers put the private and social costs – secondhand smoke, Medicare, etc. – of a lifetime of smoking at $40 per pack

Pennsylvania State Researchers calculated the cost of a pack to state governments, as part of a series of cost-benefit analyses to determine the potential savings created by programs to help people quit. The study found that, overall, for every dollar spent on smoking cessation programs, states could save $0.86 to $2.52.

On average, a pack of cigarettes in the U.S. costs a smoker $5.51, while the combined medical costs and productivity losses attributable to each pack are approximately $18.05, according to the researchers.

The numbers vary, but the bottom line, say the researchers, is that a better understanding of the real costs of smoking will help stamp out the unhealthy behavior.

"The estimated cost of premature death from a pack of cigarettes is a key element in the cost-benefit analysis of policies designed to prevent and control smoking," they wrote.

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