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Federico Augustovski , director of the Department of Health Technology Assessment and Health Economics at the IECS and another co-author of the study, concluded that " the calculated estimate of the economic impact of smoking is conservative , because only the direct medical expenses of treating the diseases it causes are considered and not, for example, the loss of productivity and other social costs , which other works estimate could be two or three times higher

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However, it is significant to study the impact of secondhand smoke and smoking habits among patients in multi-center hospital settings, with a longitudinal study design