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Reducing Tobacco Use and Secondhand Smoke Exposure: Reducing Out-of-Pocket Costs for Evidence-Based Cessation Treatments

Reducing tobacco users' out-of-pocket costs involves policy or program changes that make evidence-based treatments, including medication, counseling or both, more affordable. To achieve this, new benefits may be provided, or changes may be made to the level of benefits offered that reduce costs or co-payments.

Policy and program changes may be communicated to tobacco users and health care providers to increase awareness, interest in quitting, and use of evidence-based treatments.

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force recommends policies and programs to reduce tobacco users' out-of-pocket costs for evidence-based cessation treatments based on strong evidence of effectiveness in increasing the number of tobacco users who quit.

Evidence is considered strong based on findings from clinic-based trials and population-based policy evaluations of reduced out-of-pocket costs for both cessation counseling and medications. Clear communication of benefit changes to both tobacco users and healthcare providers increases use and impact of these interventions.

Task Force Finding and Rationale Statement

Results from the Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2001 (Hopkins, et al., search period 1980-May 2000) combined with more recent evidence (search period January 2000-July 2012). It updates the previous Task Force finding on Reducing Client Out-of-Pocket Costs.

Eighteen studies were included in the review (5 from the previous review and 13 from the more recent search period). Included studies offered evidence-based treatments identified in Treating Tobacco Use and Dependence: 2008 Update (Fiore et al., 2008).

  • Quit rates among tobacco users at follow-up periods of 3.5 months or longer: median absolute increase of 4.3 percentage points (interquartile interval [IQI]: 0.2 to 6.0 percentage points; 12 studies)
  • Quit attempt rates: median absolute increase of 2.8 percentage points (IQI: -0.6 to 9.1 percentage points; 6 studies)
  • Use of evidence-based cessation treatments among tobacco users attempting to quit: median absolute increase of 7.0 percentage points (IQI: 1.4 to 18.3 percentage points; 11 studies)
  • Reductions in the prevalence of tobacco use were seen in two different populations (state employees and retirees in Wisconsin; Medicaid recipients in Massachusetts) after the provision of a new tobacco cessation benefit (2 studies).
  • In 13 of the 18 included studies, evidence-based treatments provided at reduced out-of-pocket cost included both medications and counseling. In the remaining five studies, only medications were provided at no or reduced out-of-pocket cost.

Economic Evidence

Fifteen studies were included in the economic review. Estimates of cost-effectiveness were assessed in comparison to a conservative threshold of $50,000 per quality adjusted life year (QALY) saved. All monetary values from studies are reported in 2010 U.S. dollars.

  • Cost-effectiveness estimates were provided in 5 studies.
    • Cost per QALY saved: median estimate $2,349/QALY (range of values: $1,290 to $24,647; 3 studies)
    • Cost per life year saved: $5,990 (1 study)
    • Cost per disability adjusted life year (a measure of life lost to death and disability) averted: $7,695 to $16,559 (1 study)
  • Cost-benefit comparisons were included in 10 studies.
    • Eight out of 10 studies found that benefits of these interventions exceeded costs within 10 years. Estimate differences were attributable to the program provider (employer or insurer), type and duration of the cessation benefits implemented, and assumptions used to calculate savings.
    • One study evaluated the Medicaid population in Massachusetts and found net savings from reduced hospitalizations for cardiovascular conditions within 2 years, with a return of $3.12 for every $1 spent.

Overall, the economic evidence indicates that interventions to reduce out-of-pocket costs for evidence-based cessation treatments are cost-effective and may provide net savings to the implementer.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to tobacco use and secondhand smoke exposure.

Supporting Materials

Publication Status

Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe External Web Site Icon to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.

References

Hopkins DP, Briss PA, Ricard CM,Husten CG, Carande-Kulis VG, Fielding JE, Alao MO, McKenna JW, Sharp DJ, Harris JR, Woollery TA, Harris KW. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke Adobe PDF File [PDF - 6.5 MB]. Am J Prev Med 2001;20(2S):16-66.

Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service. May 2008.




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Reducing tobacco use and secondhand smoke exposure: reducing out-of-pocket costs for evidence–based tobacco cessation treatments. www.thecommunityguide.org/tobacco/outofpocketcosts.html. Last updated: MM/DD/YYYY.

Review completed: August 2012