A pragmatic, randomized, controlled study evaluating the impact of access to smoking cessation pharmacotherapy coverage on the proportion of successful quitters in a Canadian population of smokers motivated to quit (ACCESSATION)

BMC Public Health. 2014 May 7;14:433. doi: 10.1186/1471-2458-14-433.

Abstract

Background: Many smokers find the cost of smoking cessation medications a barrier. Financial coverage for these medications increases utilization of pharmacotherapies. This study assesses whether financial coverage increases the proportion of successful quitters.

Methods: A pragmatic, open-label, randomized, controlled trial was conducted in 58 Canadian sites between March 2009 and September 2010. Smokers (≥10 cigarettes/day) without insurance coverage who were motivated to quit within 14 days were randomized (1:1) in a blinded manner to receive either full coverage eligibility for 26 weeks or no coverage. Pharmacotherapies covered were varenicline, bupropion, or nicotine patches/gum. Investigators/subjects were unblinded to study group assignment after randomization and prior to choosing a smoking cessation method(s). All subjects received brief smoking cessation counseling. The primary outcome measure was self-reported 7-day point prevalence of abstinence (PPA) at week 26.

Results: Of the 1380 randomized subjects (coverage, 696; no coverage, 684), 682 (98.0%) and 435 (63.6%), respectively, were dispensed at least one smoking cessation medication dose. The 7-day PPA at week 26 was higher in the full coverage versus no coverage group: 20.8% (n = 145) and 13.9% (n = 95), respectively; odds ratio (OR) = 1.64, 95% confidence interval (CI) 1.23-2.18; p = 0.001. Urine cotinine-confirmed 7-day PPA at week 26 was 15.7% (n = 109) and 10.1% (n = 69), respectively; OR = 1.68, 95% CI 1.21-2.33; p = 0.002. After pharmacotherapy, coverage eligibility was withdrawn from the full coverage group, continuous abstinence between weeks 26 and 52 was 6.6% (n = 46) and 5.6% (n = 38), in the full coverage and no coverage groups, respectively; OR = 1.19, 95% CI 0.76-1.87; p = 0.439.

Conclusions: In this study, the adoption of a smoking cessation medication coverage drug policy was an effective intervention to improve 26-week quit rates in Canada. The advantages were lost once coverage was discontinued. Further study is required on the duration of coverage to prevent relapse to smoking. (clinicaltrials.gov identifier: NCT00818207; the study was sponsored by Pfizer Inc.).

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Benzazepines / economics
  • Benzazepines / therapeutic use
  • Bupropion / economics
  • Bupropion / therapeutic use
  • Canada
  • Female
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance, Health / economics
  • Insurance, Health / statistics & numerical data*
  • Male
  • Middle Aged
  • Motivation*
  • Nicotine / administration & dosage
  • Nicotine / economics
  • Nicotinic Agonists / economics
  • Nicotinic Agonists / therapeutic use
  • Quinoxalines / economics
  • Quinoxalines / therapeutic use
  • Smoking / drug therapy
  • Smoking / economics
  • Smoking Cessation / economics*
  • Smoking Cessation / methods*
  • Smoking Cessation / statistics & numerical data
  • Tobacco Use Cessation Devices / economics
  • Tobacco Use Disorder / drug therapy*
  • Tobacco Use Disorder / economics
  • Treatment Outcome
  • Varenicline

Substances

  • Benzazepines
  • Nicotinic Agonists
  • Quinoxalines
  • Bupropion
  • Nicotine
  • Varenicline

Associated data

  • ClinicalTrials.gov/NCT00818207