Use and Cost Effectiveness of Smoking-Cessation Services under Four Insurance Plans in a Health Maintenance Organization

Curry, Susan J.; Grothaus, Louis C.; McAfee, Tim; Pabiniak, Chester

doi:10.1056/nejm199809033391006

Cited by 282 publications

(265 citation statements)

References 22 publications

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“…In the study by Curry et al [19], although they showed that the rates of smoking cessation were lower in patients for whom treatment costs were completely met by employers, more patients could quit smoking because more smokers were able to access free treatment. Similarly, in our study, more patients could be treated in the free period and more patients could quit smoking, but smoking cessation rates after one year were found to be very low, in fact lower than that in the second period (10.5% vs. 18.2%).…”

Section: Discussionmentioning

confidence: 98%

Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently?

Fidan¹,

Çağlayan²,

Parmaksız³

et al. 2015

Turk Thorac J

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OBJECTIVES:In 2011, in the context of a research project, bupropion and varenicline were distributed to smoking cessation clinics by the Ministry of Health of Turkey to be prescribed free of charge by a computer-based system. In the present study, we compared smoking cessation rates between patients who were prescribed free medications during the period of the project and those who had to pay for their medication. MATERIAL AND METHODS:Six hundred four patients who applied during the project period were given either bupropion or varenicline, which were prescribed using an algorithm-based computer system. Three hundred sixteen patients who applied after that period were prescribed medicines deemed appropriate by the attending physician but had to pay for the medication on their own. Follow-up visits were arranged for one year. Carbon monoxide (CO) levels in the expired air were used as indicators of cessation. RESULTS:A total of 537 patients began treatment, of which 438 (81.6%) applied during the first period (group 1) and 99 (18.4%) applied during the second period (group 2). The mean age and concomitant disease presence were higher in the second-period patients (p< 0.05). Advanced age, comorbidities, pathological findings in spirometry, and chest X-ray were also higher in those who paid for the cost of their treatment (p= 0.009, 0.001, 0.006, 0.001, respectively). Smoking cessation rates were found to be 14.8% and 27.3% after six months (p= 0.008) and 10.7% and 18.2% after one year (p= 0.059), respectively, for group 1 and group 2. Age, dependence score, cigarettes smoked (as pack-years), and percentage of patients who paid for the treatment were found to be significantly higher (p< 0.001, 0.021, 0.018, 0.001, respectively) for those who quit smoking at the end of six months. For the patients who quit smoking at the end of one year, age was found to be significantly higher (p= 0.008), and the number of males was higher, although the difference was not statistically significant (p= 0.05). When logistic regression analysis was applied, age, dependence score, and paid treatment were found to be independent variables (p= 0.002, 0.008, 0.012, respectively) for those who quit smoking at the end of six months. Only age was found to be an independent variable for those who quit smoking at the end of one year (p= 0.029). CONCLUSION:More smokers could receive treatment by the distribution of free drugs. However, quitting rates at the end of six months were higher when patients had to pay for their treatment. On the other hand, quitting rates at the end of one year were not affected by whether the treatment was paid for or free of charge. The most important factor increasing quitting rates at the end of six months and one year was found to be advanced age.

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Section: Discussionmentioning

confidence: 98%

Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently?

Fidan¹,

Çağlayan²,

Parmaksız³

et al. 2015

Turk Thorac J

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“…Using data from two randomized pharmacogenetic trials of tobacco dependence treatment, we have estimated the potential effect on treatment costs and long-term survival of using genetic testing to choose between TN and bupropion for individual smokers. Our approach differs from the previous cost-effectiveness analyses of tobacco dependence treatment [30][31][32][33][34][35][36] in the following ways: (i) we consider Under all parameter combinations that we considered, non-tailored varenicline was the most effective (and expensive) admissible treatment. Bupropion was dominated only in the best-case scenario.…”

Section: Discussionmentioning

confidence: 99%

“…Although others have investigated the cost-effectiveness of pharmacologic smoking-cessation interventions, [30][31][32][33][34][35][36][37] we are the first to include a pharmacogenetic tailoring arm in such an evaluation. These previous studies have suggested that pharmacotherapy is cost-effective compared to no treatment or counseling alone, with ICERs in the range of $800-$1200 per quitter and $900-$11 200 per LY, depending on the regimen and the age and sex of the smoker.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment

et al. 2008

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We evaluated the cost-effectiveness of a range of smoking cessation drug treatments, including varenicline, transdermal nicotine (TN), bupropion and the use of a genetic test to choose between TN and bupropion. We performed Monte Carlo simulation with sensitivity analysis, informing analyses with published estimates of model parameters and current prices for genetic testing and smoking-cessation therapy. The primary outcomes were discounted life-years (LY) and lifetime tobacco-cessation treatment costs. In the base case, varenicline treatment was optimal with an ICER, compared to bupropion, of $2985/LY saved. In sensitivity analyses, varenicline was in all cases (and bupropion in most cases) admissible; only under favorable assumptions was the genetically tailored approach competitive. Our data suggest that an untailored approach of treatment with either bupropion or varenicline is a cost-effective form of tobacco dependence treatment, but a tailored approach for selecting between TN and bupropion can be cost-effective under plausible assumptions.

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“…Effective smoking cessation programs have the potential to dramatically decrease health care utilization and costs [41][42][43][44]. A cost-benefit analysis found that the ratio of benefits to cost varies from US$0.80 to US$2.40 saved per dollar spent on smoking cessation programs, depending upon the type of intervention [45].…”

Section: Original Researchmentioning

confidence: 99%

Implementing point of care “e-referrals” in 137 clinics to increase access to a quit smoking internet system: the Quit-Primo and National Dental PBRN HI-QUIT Studies

Sadasivam

Hogan

Volkman

et al. 2013

Behav. Med. Pract. Policy Res.

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Integrating electronic referral systems into clinical practices may increase use of web-accessible tobacco interventions. We report on our feasibility evaluation of using theory-driven implementation science techniques to translate an e-referral system (ReferASmoker.org) into the workflow of 137 community-based medical and dental practices, including system use, patient registration, implementation costs, and lessons learned. After 6 months, 2,376 smokers were e-referred (medical, 1,625; dental, 751). Eighty-six percent of the medical practices [75/87, mean referral = 18.7 (SD=17.9), range 0-105] and dental practices [43/50, mean referral = 15.0 (SD=10.5), range 0-38] had e-referred. Of those smokers e-referred, 25.3 registered [mean smoker registration rate-medical 4.9 (SD=7.6, range 0-59), dental 3.6 (SD= 3.0, range 0-

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Use and Cost Effectiveness of Smoking-Cessation Services under Four Insurance Plans in a Health Maintenance Organization

Cited by 282 publications

References 22 publications

Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently?

Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently?

Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment

Implementing point of care “e-referrals” in 137 clinics to increase access to a quit smoking internet system: the Quit-Primo and National Dental PBRN HI-QUIT Studies

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