Variations in treatment benefits influence smoking cessation: results of arandomised controlled trial

Objective-To assess the impact and costs of coverage for tobacco dependence treatment benefits with no patient cost sharing for smokers with employer sponsored coverage in two large independent practice association (IPA) mode l health maintenance organisations (HMOs) in California, USA. Methods-A randomised experimental design was used. 1204 eligible smokers we re randomly assigned either to the control group, which received a self-hel p kit (video and pamphlet), or to the treatment group, which received the s elf-help kit and fully covered benefits for over the counter (OTC) nicotine replacement therapy (NRT) gum and patch, and participation in a group beha vioural cessation programme with no patient cost sharing. Results-The quit rates after one year of follow up were 18% in the treatmen t group and 13% in the control group (adjusted odd ratio (OR) 1.6, 95% conf idence interval (CI) 1.1 to 2.4), controlling for health plan, sociodemogra phics, baseline smoking characteristics, and use of bupropion. Rates of qui t attempts (adjusted OR 1.4, 95% CI 1.1 to 1.8) and use of nicotine gum or patch (adjusted OR 2.3, 95% CI 1.6 to 3.2) were also higher in the treatmen t group. The annual cost of the benefit per user who quit ranged from $1495 to $965 or from $0.73 to $0.47 per HMO member per month. Conclusions-Full coverage of a tobacco dependence treatment benefit impleme nted in two California has been shown to be an effective and relatively low cost strategy for significantly increasing quit rates, quit attempts, and use of nicotine gum and patch in adult smokers.