The association between smoking cessation outpatient visits and total medical costs: a retrospective, observational analysis of Japanese employee-based public health insurance data

J Med Econ. 2018 May;21(5):443-449. doi: 10.1080/13696998.2018.1426590. Epub 2018 Feb 1.


Aims: The short-term effects of smoking cessation (SC) on overall healthcare costs are unclear. This study aimed to compare the short-term medical costs between patients with SC outpatient visits (SCOVs) and those without SCOVs, consisting of SCOV itself and overall medical costs.

Materials and methods: This study is a retrospective, observational study using a Japanese employee-based health insurance claims database (January 1, 2005-December 31, 2013). It analyzed individuals who were registered as smokers based on their medical checkup details. It compared the per-patient-per-year (PPPY) medical costs for male smokers who made ≥1 claim for SCOVs with those who made no claims. We also assessed whether the number of SCOVs by male and female smokers impacted medical costs. The Index Year was the year after the first SCOV claim and that after the first registration as a smoker (non-SCOV group). Medical costs were calculated using regression analysis and adjusted for baseline costs.

Results: In Index Year -1, PPPY medical costs for male smokers were ∼USD 323.01 (JPY 36,500, as of November 2017) higher in the SCOV (n = 5,608) vs the non-SCOV (n = 81,721) group; however, by Year 6 the costs were similar. From Year 4-6, PPPY medical costs for SCOVs were lower than those in the adjusted non-SCOV group. For 2,576 male and female smokers in the SCOV group, the average rates of increasing medical costs before and after the SCOV for 1, 2, 3, 4, and 5 SCOVs made were 58%, 44%, 50%, 41%, and 34%, respectively.

Limitations: The database includes limited data on individuals >65 years. Only SCOVs based on claims data and not on other outcomes were assessed.

Conclusions: Medical costs declined in the short-term following the first SCOV. Attendance at a greater number of SCOVs was associated with a lower increase ratio of medical costs.

Keywords: Smoking cessation; claims data; health insurance; medical costs; outpatient visits.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Female
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • Japan
  • Male
  • Middle Aged
  • Models, Econometric
  • Outpatients*
  • Retrospective Studies
  • Smoking Cessation / economics*
  • Time Factors
  • Young Adult