Smoking tobacco contributes to the highest economic burden among Kerala males with direct costs of Rs 123.5 crore and indirect costs of Rs 62.7 crore, it said.
It estimated the economic costs on persons in the 35-69 age group in 2011.
Significantly, the total direct medical costs from tobacco-induced cardiovascular diseases (CVDs) in Kerala are the highest among the south Indian states.
It covers both direct medical costs and indirect morbidity costs of four specific diseases - CVDs, cancer, tuberculosis, and respiratory disease.
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The direct medical costs from tobacco-related heart diseases in Tamil Nadu is 46 per cent, while those in Andhra Pradesh and Karnataka are at 48 and 40 per cent respectively.
Direct medical costs include direct healthcare expenses for in-patient hospitalisation or outpatient visits like medicines, diagnostic tests, bed charges and surgeon's fees.
According to Global Adult Tobacco Survey (GATS) 2009-10, the global standard to systematically monitor adult tobacco use, 35.5 per cent of males use tobacco in some form, 27.9 per cent males smoke and 13.1 per cent use smokeless tobacco products.
The study has suggested a host of steps to deal with the tobacco menace. These include strengthening implementation of Indian tobacco control law, Control of Tobacco Products Act (COTPA), 2003 and imposing uniform taxes on all tobacco products like cigarettes and bidis.