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A cost–benefit analysis of smoking cessation prescription coverage from a US payer perspective

Authors Baker CL, Ding Y, Ferrufino CP, Kowal S, Tan J, Subedi P

Received 14 February 2018

Accepted for publication 14 May 2018

Published 16 July 2018 Volume 2018:10 Pages 359—370


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 2

Editor who approved publication: Professor Giorgio Lorenzo Colombo

Christine L Baker,1 Yao Ding,2 Cheryl P Ferrufino,2 Stacey Kowal,2 Jenen Tan,3 Prasun Subedi1

1Patient & Health Impact, Pfizer, Inc, New York, NY, USA; 2Health Economics & Outcomes Research, Real World Evidence Solutions, IQVIA, Fairfax, VA, USA; 3IQVIA, San Francisco, CA, USA

Introduction: Smoking drives substantial direct health care spending, comprising 8.7% ($168 billion) of annual United States aggregated spending. Smoking cessation (SC) prescription use is an effective strategy to improve health outcomes, increase quit rates, and reduce economic burden. However, patient out-of-pocket costs may limit the use. Health care payers play a vital role in driving use through formulary decisions and copayment policies but must consider both the near-term financial investment as well as downstream effects of increased coverage on health care budgets. This study estimates the return on investment (ROI) of providing Affordable Care Act (ACA)-recommended prescription SC coverage.
Methods: A cost–benefit analysis (CBA) estimates the ROI of providing prescription SC ­coverage, based on pharmacy costs and savings from smoking-attributable medical expenditures among Medicare, Medicaid, and commercial plan enrollees over 10 years. The CBA incorporated national-level population demographics, smoking prevalence estimates, proportion of smokers attempting to quit, and the utilization of SC products. A five-state Markov chain model simulated patterns of quit attempts, relapse, and cessation assuming two quit attempts per year, no patient cost-sharing, and 25.4% utilization of prescription SC aids. Results include number of quitters, annual pharmacy and smoking-attributable medical costs, and ROI.
Results: After initial investment in SC treatment, smoking-attributable medical benefits accrue over time, generating a positive ROI by year 4 for commercial (11.3%) and Medicaid (78.4%) plans and by year 3 for Medicare (30.6%). Over 10 years, an average return of $1.18, $2.50, and $3.22 savings per dollar spent on SC prescriptions for commercial, Medicaid, and Medicare plans, respectively, may be realized.
Discussion: Given the proven efficacy of SC pharmacotherapy, near-term investments in supporting ACA-recommended SC coverage translate into a positive ROI. As smoking is a leading cause of morbidity and mortality, increased access to prescription SC medications may improve health outcomes and reduce smoking-attributable costs to payers over time.

Keywords: cost–benefit analysis, smoking cessation prescription coverage, smoking-attributable medical cost, return on investment

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