Background & Objective(s): The growing burden of non-communicable diseases (NCDs) in developing countries has highlighted the importance of monitoring the economic cost of tobacco use. The aim of this work was to calculate the inpatient smoking-attributable health care expenditure (SAE) for cardiovascular diseases (CVDs) and chronic respiratory diseases (CRDs) among adults in Alexandria, Egypt. Methods: A household survey was carried out in Alexandria, Egypt and included 1354 adults. To estimate one of the direct healthcare costs of smoking, namely the inpatient costs of treating smoking-related CVDs and CRDs, a predesigned structured interviewing questionnaire was used to collect data on smoking status, history of CVDs and CRDs, number of inpatient admissions and expenditure per inpatient hospitalization. Estimation of the SAE for CVDs and CRDs among ever smokers in Alexandria was carried out based on the World Health Organization (WHO) economics of tobacco toolkit. Results: About 56% of adults were ever smokers. Ever smokers had 7.7 and 2.015 times more risk for CVDs and CRDs compared to never smokers. About 79% of CVDs and 36% of CRDs among ever smokers were attributed to smoking. The SAE on inpatient care for CVDs and CRDs among ever smokers in Alexandria was equivalent to US$ 257 million and 10.256 million annually, respectively. Conclusion: The cost of inpatient SAE for CVDs and CRDs is enormous. Tobacco control is a very important element in achieving sustainable development goals.