Smoking cessation: the value of a comprehensive carved-in benefit.
ABSTRACT This qualitative narrative review examines the potential returns from providing smoking cessation treatments (SCTs) through an insurance plan's standard benefit package versus through an optional supplementary wellness ('rider') program. Research indicates most employers offer SCTs as part of a rider available for purchase. Studies demonstrate that the higher the cost of SCTs, the lower the SCT participation rates; when employees receive SCTs, smoking cessation rates increase, effecting lower employee healthcare costs and improved productivity. Employers may receive a considerable return on the investment of offering SCTs as part of comprehensive insurance benefit for their employees as opposed to a rider.
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ABSTRACT: While smoking cessation interventions have been shown to work, questions remain about how to increase their efficacy. To examine strategies for effective tobacco treatment in adults and special populations. MEDLINE, Cumulative Index to Nursing and Applied Health (CINAHL), Cochrane Library, Cochrane Clinical Trials Register, Psychological Abstracts, and Sociological Abstracts (1 January 1980 to 10 June 2005). Systematic reviews; randomized, controlled trials; and observational studies. Two reviewers independently abstracted data on study design, population, sample size, treatment, outcomes, and quality. Findings from systematic reviews were summarized and compared with findings from original research published beyond date ranges included in the reviews. Strength of evidence was used to assess the body of evidence. Our review included studies evaluating the efficacy of cessation strategies, such as self-help, counseling, single pharmaceutical agents, combined pharmacotherapies, and pharmacotherapies combined with psychological counseling. Research findings consistent with previous reviews show that self-help strategies alone are ineffective, but counseling and pharmacotherapy used either alone or in combination can improve rates of success with quit attempts. Two studies of self-help materials reported discrepancies across effects. Five studies provided mixed results for counseling interventions. Fourteen studies provided sufficient evidence of the efficacy of single pharmacotherapy, combined pharmacotherapy, and psychological interventions either with or without pharmacotherapy. Few studies focused on ways to reach or treat special populations. Three studies with hospitalized patients had findings consistent with a previous review showing no strong evidence that clinical diagnosis affected the likelihood of quitting. New evidence was insufficient to address the effectiveness of interventions for persons with coexisting psychiatric conditions and substance abuse problems. Previous systematic reviews variably cover the range of issues we addressed. More recent studies do not fill all gaps, especially those for persons with coexisting disease. Although self-help strategies alone marginally affect quit rates, individual and combined pharmacotherapies and counseling either alone or in combination can significantly increase cessation. Using effective smoking treatments is strongly encouraged for all populations, especially those with high and heavy rates of smoking, such as psychiatric and substance abuse populations.Annals of internal medicine 01/2007; 145(11):845-56. · 16.10 Impact Factor
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ABSTRACT: Increasing the use of effective smoking cessation aids could in principle have a substantial public health impact. The UK government has undertaken several major policy initiatives to try to increase usage of smoking cessation medicines. It is important to evaluate what effect, if any, these have had to inform future policy in the UK and internationally. This study used sales data to examine the impact of government initiatives to increase access to smoking cessation medicines. Information about prescription and non-prescription sales (1999-2002) was obtained. Estimates of utilisation were compared with findings from the Office of National Statistics (ONS) omnibus surveys. The effects of policy initiatives (making the medicines reimbursable and making them available on general sale outside pharmacies) were assessed by means of time series analysis. In addition a new nicotine replacement therapy (NRT) product (a nicotine lozenge) was launched and the effect of this on total utilisation was assessed. Making bupropion, and subsequently nicotine replacement therapy (NRT), reimbursable had a major impact in medication usage; the estimated increase in each case was more than 80 000 "treatment weeks" purchased per month. In addition, introduction of a nicotine lozenge increased total utilisation and did not detract from usage of other medicines. According to both the sales and the survey data, the proportion of smokers using medicines to aid smoking cessation more than doubled from 8-9% in 1999 to 17% in 2002. The ONS surveys showed no increase in the proportions of smokers making quit attempts and so the effects were solely on the proportions of quit attempts that were aided by medication. In the UK, making smoking cessation medicines reimbursable led to a large increase in utilisation. While the effect on smoking prevalence would be too small to be detected in national surveys it could have a substantial public health impact.Tobacco control 07/2005; 14(3):166-71. · 3.85 Impact Factor
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ABSTRACT: To investigate the costs and benefits of covering smoking cessation interventions from insurers' and employers' perspectives. A Monte Carlo model was used to simulate smoking status and health expenditures in a hypothetical population of employees over a period of 20 years. Population characteristics were drawn from the 1997-2002 National Health Interview surveys. Multivariate regressions using a number of publicly available datasets from 1996-2002 generated transition probabilities for the simulation. The costs and benefits of scenarios where smoking cessation treatments were covered were compared with a scenario where none were covered. Sensitivity to parameter estimates was evaluated. By the final simulation year, insurers had benefit-cost ratios of 0.56 to 1.67 with per member per month costs of -$0.22 to $0.43. The earliest year at which savings were achieved for insurers was year 8. Employers saw benefit-cost ratios of 1.88 to 5.58 by the final simulation year with per member per month costs of -$1.23 to -$0.15. Employers achieved savings as early as year 3 and as late as year 8. Models were sensitive to the rate at which population members were assumed to exit the insurer or employer. Both insurers and employers may add smoking cessation benefits at minimal burden to their members and with potential savings, particularly where the population of interest is relatively stable.The American journal of managed care 10/2006; 12(9):553-62. · 2.17 Impact Factor