Healthcare costs around the time of smoking cessation

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 (1346 total participants; 1338 with requisite data for further analysis). 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: ClinicalTrials.gov NCT00296647.

Figure 1

Total inpatient and outpatient costs by subsample