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Study: Lifetime Cost Per Mass. Smoker: $4.8 Million

By Tom Marino | January 10, 2024
Last Updated: January 10, 2024

Mass. – A new study found that the average total financial cost over a lifetime to a pack-a-day smoker in Massachusetts is $4,867,778, when including financial opportunity costs. The study found the out-of-pocket costs are $199,202. When compared to the other 49 states and the District of Columbia (Washington D.C.), the cost in Massachusetts  is 6th highest.

The study added out-of-pocket costs, healthcare costs, income loss, financial opportunity costs, and other costs to arrive at a total cost per smoker. Financial opportunity costs, by far the largest contributor to overall costs, was calculated by comparing the cost of tobacco against if that money was invested in the S&P 500.

The value of income loss was calculated through several metrics. According to the study:

“Previous studies have shown that smoking can lead to loss of income, either because of absenteeism, workplace bias or lower productivity due to smoking-related health problems. This can create a wage gap between smokers and nonsmokers. To represent the negative relationship between earnings and smoking, we assumed an average 18 percent decrease in the median household income for each state. We arrived at this figure after a recent survey from National Longitudinal Surveys found that smokers earn 18.1 percent less than nonsmokers.”

The study found the following costs and rank from highest to lowest in each of the categories considered over the lifetime of a Massachusetts smoker:

  • Out-of-Pocket: $199,202 (6)
  • Financial Opportunity: $3,548,285 (6)
  • Healthcare: $333,016 (2)
  • Income Loss: $769,185
  • Other Costs: $18,090

The five states with higher lifetime costs for smokers in the study, from starting with the highest:

  • New York – $5,188,634
  • District of Columbia – $5,100,092
  • Maryland – $4,970,008
  • Connecticut – $4,938,378
  • Rhode Island – $4,913,129

The five least expensive states, according to the study:

  • North Dakota – $2,993,994
  • North Carolina – $2,988,828
  • Alabama – $2,891,150
  • Missouri – $2,884,320
  • Mississippi – $2,841,933

To see the full rankings and methodology of the study, visit

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