BACKGROUND: Tobacco smoking is the cause of many preventable diseases and premature deaths in the UK and around the world. It poses enormous health- and non-health-related costs to the affected individuals, employers, and the society at large. The World Health Organization (WHO) estimates that, globally, smoking causes over US500billionineconomicdamageeachyear.OBJECTIVES:ThispaperexaminesglobalandUKevidenceontheeconomicimpactofsmokingprevalenceandevaluatestheeffectivenessandcosteffectivenessofsmokingcessationmeasures.STUDYSELECTIONSearchmethods:Weusedtwomajorhealthcare/economicresearchdatabases,namelyPubMedandtheNationalInstituteforHealthResearch(NIHR)databasethatcontainstheBritishNationalHealthService(NHS)EconomicEvaluationDatabase;CochraneLibraryofsystematicreviewsinhealthcareandhealthpolicy;andotherhealth−care−relatedbibliographicsources.Wealsoperformedhandsearchingofrelevantarticles,healthreports,andwhitepapersissuedbygovernmentbodies,internationalhealthorganizations,andhealthinterventioncampaignagencies.Selectioncriteria:Thepaperincludescost−effectivenessstudiesfrommedicaljournals,healthreports,andwhitepaperspublishedbetween1992andJuly2014,butincludedonlyeightrelevantstudiesbefore1992.Mostofthepapersreviewedreportedoutcomesonsmokingprevalence,aswellasthedirectandindirectcostsofsmokingandthecostsandbenefitsofsmokingcessationinterventions.Weexcludedpapersthatmerelydescribedtheeffectivenessofaninterventionwithoutincludingeconomicorcostconsiderations.Wealsoexcludedpapersthatcombinesmokingcessationwiththereductionintheriskofotherdiseases.Datacollectionandanalysis:TheincludedstudieswereassessedagainstcriteriaindicatedintheCochraneReviewersHandbookversion5.0.0.Outcomesassessedinthereview:Primaryoutcomesoftheselectedstudiesaresmokingprevalence,directandindirectcostsofsmoking,andthecostsandbenefitsofsmokingcessationinterventions(e.g.,“costperquitter”,“costperlifeyearsaved”,“costperquality−adjustedlifeyeargained,”“presentvalue”or“netbenefits”fromsmokingcessation,and“costsavings”frompersonalhealthcareexpenditure).MAINRESULTS:Themainfindingsofthisstudyareasfollows:1.Thecostsofsmokingcanbeclassifiedintodirect,indirect,andintangiblecosts.About15151 billion. 2. The costs of smoking notwithstanding, it produces some potential economic benefits. The economic activities generated from the production and consumption of tobacco provides economic stimulus. It also produces huge tax revenues for most governments, especially in high-income countries, as well as employment in the tobacco industry. Income from the tobacco industry accounts for up to 7.4% of centrally collected government revenue in China. Smoking also yields cost savings in pension payments from the premature death of smokers. 3. Smoking cessation measures could range from pharmacological treatment interventions to policy-based measures, community-based interventions, telecoms, media, and technology (TMT)-based interventions, school-based interventions, and workplace interventions. 4. The cost per life year saved from the use of pharmacological treatment interventions ranged between US128andUS1,450 and up to US4,400perquality−adjustedlifeyears(QALYs)saved.Theuseofpharmacotherapiessuchasvarenicline,NRT,andBupropion,whencombinedwithGPcounselingorotherbehavioraltreatmentinterventions(suchasproactivetelephonecounselingandWeb−baseddelivery),isbothclinicallyeffectiveandcosteffectivetoprimaryhealthcareproviders.5.Price−basedpolicymeasuressuchasincreaseintobaccotaxesareunarguablythemosteffectivemeansofreducingtheconsumptionoftobacco.A102 to US112perlifeyeargained(LYG)whilereducingsmokingprevalencebyupto30500 and US614perLYG.7.Advertisingmedia,telecommunications,andothertechnology−basedinterventions(suchasTV,radio,print,telephone,theInternet,PC,andotherelectronicmedia)usuallyhavepositivesynergisticeffectsinreducingsmokingprevalenceespeciallywhencombinedtodeliversmokingcessationmessagesandcounselingsupport.However,theoutcomesonthecosteffectivenessofTMT−basedmeasureshavebeeninconsistent,andthismadeitdifficulttoattributeresultstospecificmedia.Thedifferencesinreportedcosteffectivenessmaybepartlyattributedtovaryingmethodologicalapproachesincludingvaryingparametricinputs,differencesinnationalcontexts,differencesinadvertisingcampaignstestedondifferentmedia,anddisparatelevelsofresourcingbetweencampaigns.Duetoitsuniversalreachandlowimplementationcosts,onlinecampaignappearstobesubstantiallymorecosteffectivethanothermedia,thoughitmaynotbeaseffectiveinreducingsmokingprevalence.8.School−basedsmokingprevalenceprogramstendtoreduceshort−termsmokingprevalencebybetween3016,400 to US580,000dependingonthescaleandscopeofintervention.Thecosteffectivenessofschool−basedprogramsshowthatonecouldexpectasavingofapproximatelybetweenUS2,000 and US20,000perQALYsavedduetoavertedsmokingafter2–4yearsoffollow−up.9.Workplace−basedinterventionscouldrepresentasoundeconomicinvestmenttobothemployersandthesocietyatlarge,achievingabenefit−costratioofupto8.75andgenerating12−monthemployercostsavingsofbetween150 and $540 per nonsmoking employee. Implementing smoke-free workplaces would also produce myriads of new quitters and reduce the amount of cigarette consumption, leading to cost savings in direct medical costs to primary health care providers. Workplace interventions are, however, likely to yield far greater economic benefits over the long term, as reduced prevalence will lead to a healthier and more productive workforce. CONCLUSIONS: We conclude that the direct costs and externalities to society of smoking far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes (i.e., in terms of a healthy population and a productive workforce). There are enormous differences in the application and economic measurement of smoking cessation measures across various types of interventions, methodologies, countries, economic settings, and health care systems, and these may have affected the comparability of the results of the studies reviewed. However, on the balance of probabilities, most of the cessation measures reviewed have not only proved effective but also cost effective in delivering the much desired cost savings and net gains to individuals and primary health care providers