Cost Effectiveness Of Smoking-Cessation Services
Article Highlights
- Study Title
- Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization
- Study Authors
- Susan J. Curry, Louis C. Grothaus, Tim McAfee, et al.
- Publication Date
- 1998
- Complete Study
- View Complete Abstract
Prior to this study, little research had been done on the relation between insurance coverage models and the utilization rates and cost effectiveness of smoking cessation services such as Free & Clear's (F&C) telephonic program. This study examines the association between amount of health plan coverage of F&C plus nicotine replacement therapy (nicotine patch or gum) and the resulting rates of utilization of service and success at quitting smoking.
Design
Study participants were employees of Group Health Cooperative of Puget Sound, Boeing Company, and local and federal employees of Washington State, for a total of 90,005. The researchers assigned one of four plans (standard, reduced, flipped, or full) to each of the four assembled employer groups. The plans differed in the amount and distribution of coverage provided, as shown in Table 1.0.
Since plan contributions varied per group, study participants (employees) had varying levels of out-of-pocket expenses for F&C and patches or gum, as shown in Table 2.0.
Table 1.0 Amount contributed by plan
| |
Standard Coverage Plan |
Reduced Coverage Plan |
Flipped Coverage Plan |
Full Coverage Plan |
| Free & Clear program |
50% |
50% |
100% |
100% |
| Gum or patches |
100% |
50% |
50% |
100% |
|
In setting coverage levels and administering the study, the researchers aimed to determine the following outcomes per level of coverage: 1.) Employee utilization rates of the F&C program; 2.) Success rate of program users (percentage quit); and 3.) Cost effectiveness of providing [some level of] coverage for F&C plus patches or gum.
Table 2.0 Employee's contribution
| |
Standard Coverage Plan |
Reduced Coverage Plan |
Flipped Coverage Plan |
Full Coverage Plan |
| Free & Clear program |
$42.50 |
$42.50 |
$0.00 |
$0.00 |
| Gum or patches* |
$10.00
(one $5 copayment per order) |
$85.00 |
$85.00 |
$10.00
(one $5 copayment per order) |
| Total |
$52.50 |
$127.50 |
$85.00 |
$10.00 |
|
* Based on cost for 1 prescription and 1 refill for patches or gum.
Findings
For data collection, the researchers administered a survey to 345 participants that was designed to capture information on outcomes of interest.
Utilization of Program
The researchers found that 53% of enrollees were women and the average age was 42 years. Moreover, almost 75% were married, 40% were college graduates, and over 80% were Caucasian. Of the enrollees, utilization of the program ranged from 2.4% to 10% based on level of coverage for the F&C program and for patches or gum. The most important difference in utilization was seen between the standard coverage plan and the full coverage plan; the full coverage plan resulted in a tripling of the overall utilization rate [compared to the standard plan].
Quit Rate
Researchers found the quit rates in the study groups (percentage of enrollees who were quit at 6 months after starting F&C's program) ranged from 28% to 38%. Again, the two main groups of interest were the standard coverage plan and the full coverage plan. Despite having three times the utilization rate as the standard plan, the full coverage plan had a quit rate of 28%. On the other hand, the less utilized standard coverage plan had quit rates of 38%. The difference between these two rates approached statistical significance, and is quite important given the utilization differences between the full coverage and standard coverage groups.
Cost Effectiveness
To determine cost effectiveness, the researchers calculated the average cost per benefit user who stopped smoking. The average cost to the health plan per user who quit ranged from $928 (with standard coverage) to $1,192 (with full coverage) - a 28% difference, mostly due to the difference in quit rates among the groups. In addition, the cost to the health plans for standard, reduced, and flipped coverage plans was almost identical due to higher average levels of cost sharing by employees under the reduced and flipped coverage plans.
Conclusion
In this study, the researchers found that utilization of the F&C program plus nicotine patches or gum varies according to the extent of coverage offered by the health plan. More specifically, they found the full coverage model attracted the highest number of users but posted the lowest rate of successful quitters. Yet, because of its higher utilization rate, the full coverage model is expected to result in more people quit per year. The researchers estimate that 10% of smokers per year would utilize F&C plus patches or gum under a full coverage plan while only 3.5% would utilize it under the standard coverage plan. Therefore, full coverage of both Free & Clear and nicotine replacement therapy is the most effective model for helping the highest number of people quit per year.