Despite evidence that demographics influence the use of pharmacotherapy in smoking cessation, there is limited and contradictory information regarding how psychiatric and chronic medical illnesses affect pharmacotherapy use. Administrative data were used to determine trends and patient characteristics of those receiving pharmacotherapy to aid in smoking cessation in the Veterans Health Administration. From 2004 to 2013, pharmacotherapy use increased from 13.8% to 25.6% of current smokers. Factors associated with increased pharmacotherapy initiation were psychiatric disorders, chronic pulmonary disease, peripheral vascular disorders, and younger age. Veterans with schizophrenia or other psychosis, males, Hispanics, and most medical conditions were less likely to receive pharmacotherapy.

No abstract

Background and aims Cost-effectiveness studies in randomized clinical trials have shown that tobacco cessation pharmacotherapy is among the most cost-effective of health-care interventions. Clinical trial eligibility criteria and treatment protocols may not be followed in actual practice. This study aimed to determine whether tobacco cessation pharmacotherapy is cost-effective in real-world settings. Design A retrospective analysis of costs and outcomes. Setting Hospitals and clinics of the US Veterans Health Administration, USA. Participants A total of 589 862 US veterans who screened positive for tobacco use in 2011. Intervention and comparator Tobacco users who initiated smoking cessation pharmacotherapy in the 6 months after screening were compared with those who did not use pharmacotherapy in this period. Pharmacotherapy included nicotine replacement therapy, bupropion (if prescribed at 300 mg per day or specifically for tobacco cessation) or varenicline. Measures Effectiveness was determined from responses to a subsequent tobacco screening conducted between 7 and 18 months after the treatment observation period. Cost of medications and prescribing health-care encounters was determined for the period between initial and follow-up tobacco use screening. Multivariate fixed-effects regression was used to assess the effect of initial treatment status on cost and outcome while controlling for differences in case-mix with propensity weighting to adjust for confounding by indication. Findings Thirteen per cent of participants received tobacco cessation pharmacotherapy within 6 months of initial screening. After an average of an additional 218.1 days' follow-up, those who initially received pharmacotherapy incurred $143.79 in additional treatment cost and had a 3.1% absolute increase in tobacco quit rates compared with those who were not initially treated. This represents an incremental cost-effectiveness ratio of $4705 per quit. The upper limit of the 99.

Relating smoking behavior to the patient's medical comorbidities may increase motivation to quit smoking among veterans.

While smoking, psychiatric and substance abuse disorders are high among veterans, there is considerable controversy over providing smoking cessation interventions to those suffering with psychiatric and substance abuse disorders. The objective of this study was to determine motivation to quit smoking among veterans experiencing psychiatric and substance abuse disorders. A convenience sample of patients recruited at a primarily psychiatric Veterans Affairs hospital completed a self-administered survey (N = 146). Means or frequencies were calculated for all variables. Bivariate and multivariate logistic regression models were examined to determine the association between psychiatric or substance abuse disorders and opinions about the importance of quitting smoking to health, thinking of quitting smoking in the next 30 days, and interest in receiving smoking cessation services. Psychiatric and substance abuse disorders were reported among 74% and 64% of patients, respectively. After controlling for nicotine dependence, age, race/ethnicity, and employment status, veterans with psychiatric disorders had 2.6 times greater odds of thinking that quitting smoking was very or extremely important to their health (p = 0.05) and 4.4 times greater odds of thinking of quitting using tobacco products in the next 30 days (p = 0.02) compared to those without psychiatric disorders. There were no differences in motivation to quit smoking among those with and without substance abuse disorders. Veterans with psychiatric disorders are motivated to quit smoking and should be offered cessation services. Veterans with substance abuse disorders may need interventions to enhance motivation to quit.