USE AND COST-EFFECTIVENESS OF SMOKING-CESSATION SERVICES UNDER 4 INSURANCE PLANS IN A HEALTH MAINTENANCE ORGANIZATION

Background Lack of information about the effect of insurance coverage on the demand for and use of smoking-cessation services has prevented widescale adoption of coverage for such services. Methods In a longitu dinal, natural experiment, we compared the use and cost effectiveness of three forms of coverage with those of a standard form of coverage f or smoking-cessation services that included a behavioral program and n icotine-replacement therapy. The study involved seven employers and a total of 90,005 adult enrollees. The standard plan offered 50 percent coverage of the behavioral program and full coverage of nicotine-repla cement therapy. The other plans offered 50 percent coverage of both th e behavioral program and nicotine-replacement therapy (reduced coverag e), full coverage of the behavioral program and 50 percent coverage of nicotine-replacement therapy (flipped coverage), or full coverage of both the behavioral program and nicotine-replacement therapy. Results Estimated annual rates of use of smoking-cessation services ranged fro m 2.4 percent (among smokers with reduced coverage) to 10 percent (amo ng those with full coverage). Smoking-cessation rates ranged from 28 p ercent (among users with full coverage) to 38 percent (among those wit h standard coverage). The estimated percentage of all smokers who woul d quit smoking per year as a result of using the services ranged from 0.7 percent (with reduced coverage) to 2.8 percent (with full coverage ). The average cost to the health plan per user who quit smoking range d from $797 (with standard coverage) to $1,171 (with full coverage). T he annual cost per smoker ranged from $6 (with reduced coverage) to $3 3 (with full coverage). The annual cost per enrollee ranged from $0.89 (with reduced coverage) to $4.92 (with full coverage). Conclusions Us e of smoking-cessation services varies according to the extent of cove rage, with the highest rates of use among smokers with full coverage. Although the rate of smoking cessation among the benefit users with fu ll coverage was lower than the rates among users with plans requiring copayments, the effect on the overall prevalence of smoking was greate r with full coverage than with the cost-sharing plans. (N Engl J Med 1 998;339:673-9.) (C)1998, Massachusetts Medical Society.