Healthcare Costs Around the Time of Smoking Cessation

• Type of Material: Article
• Authors: Jason Michael Hockenberry, Emory University; Susan J. Curry, University of Iowa; Paul A. Fishman, Group Health Cooperative; Timothy B. Baker, University of Wisconsin Madison; David L. Fraser, University of Wisconsin Madison; Ron A. Cisler, University of Wisconsin Madison; Thomas C. Jackson, University of Wisconsin Madison; Michael C. Fiore, University of Wisconsin Madison
• Language: English
• Date: 2012-06
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amepre.2012.02.019
• Title of Journal or Parent Work: American Journal of Preventive Medicine
• ISSN: 0749-3797
• Volume: 42
• Issue: 6
• Start Page: 596
• End Page: 601
• Grant/Funding Information: This research was funded by P50 DA019706-100002 Natural History of Smoking & Quitting: Longterm Outcomes.
• Research Categories: Health Sciences, Public Health

Abstract

Background The Affordable Care Act mandates that new insurance plans cover smoking-cessation therapy without cost-sharing. Previous cost difference estimates, which show a spike around the time of cessation, suggest premiums might rise as a result of covering these services. Purpose The goal of the study was to test (1) whether individuals in an RCT of pharmacotherapy and counseling for smoking cessation differed in their healthcare costs around the cessation period, and (2) whether the healthcare costs of those in the trial who successfully quit were different from a matched sample of smokers in the community. Methods Generalized linear regression models were used to analyze healthcare cost data on individuals enrolled in a comparative effectiveness trial of cessation therapies between October 2005 and May 2007. Cost differences for the period preceding and subsequent to the cessation attempt were assessed by trial participants' 12-month sustained quit status. Healthcare cost differences between sustained quitters and a sample of community-dwelling smokers, matched to these quitters on the basis of health services use around the time trial participant enrolled and by demographics, were also examined. Data were analyzed in 2011. Results All three groups had a spike in cost associated with the index clinic visit. Regression results revealed little difference in healthcare costs by quit status for trial participants until the sixth quarter post-quit. By that quarter, continuous sustained quitters cost $541 (p<0.001) less than continuing smokers. Continuous sustained quitters cost less than their matched community-dwelling smokers in almost every quarter observed. The cost difference ranged from $270 (p=0.01) during the quarter of quit, to $490 (p<0.01) in the 6th quarter after quitting. Conclusions The inclusion of smoking-cessation therapy does not appear to raise short-term healthcare costs. By the sixth quarter post-quit, sustained quitters were less costly than trial participants who continued smoking. Trial registration This study is registered at clinicaltrials.gov NCT00296647.