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Smoking cessation and medical care use/costs in a large HMO

Institution: University of California, San Francisco
Investigator(s): Hai-Yen Sung, Ph.D.
Award Cycle: 2003 (Cycle 12) Grant #: 12RT-0216 Award: $337,964
Subject Area: Public Health, Public Policy, and Economics
Award Type: Research Project Awards

Initial Award Abstract
This study focuses on analyzing smoking cessation and its impacts on the utilization and costs of medical care services for members in a large HMO in California. It has two objectives. First, it will analyze the association of receipt of physician advice to quit smoking, use of nicotine replacement drugs, participation in smoking cessation programs, and other risk factors with smoking cessation attempts and successful quitting. The second objective is to estimate and compare the medical care utilization and costs for current smokers, former smokers, and never smokers per year. The medical care services include hospitalization, clinic visits, and prescription medicines. We will test whether current smokers, recent quitters, and longtime quitters incur excess medical care utilization and costs per year. We will also test whether these excess costs are mainly attributed to treatment for smoking-caused diseases.

Estimates for the first objective have been completed. The study cohort consisted of 5,939 current smokers and recent quitters who quit in the past 12 months. Having received physician advice to quit, participated in smoking cessation programs, participated in health education programs, and used nicotine replacement drugs in the past 12 months were found to significantly increase the likelihood of having quit attempts in the past 12 months and the odds ratios were 1.24, 4.53, 1.15, and 13.45, respectively. There were 2,889 recent smokers who made quit attempts in the past 12 months. Among them, those who participated in smoking cessation programs or health education programs, or who had used nicotine patches in the past 12 months were more likely to quit successfully with an odds ratio of 1.03, 1.14, and 1.06, respectively. Having tobacco-caused diseases in the past 12 months was a strong predictor for both quit attempts and successful quitting.

In the second year of the study, the annual medical care utilization and costs for current smokers, former smokers, and never smokers will be estimated separately. We will estimate the excess costs incurred by former smokers by the length of time since they quit. We will assess whether the excess costs are mainly caused by treating tobacco-related diseases, and whether there are gender-specific differences in the excess costs. Our results will help identify key smoking cessation interventions that have contributed to quit attempts and smoking cessation by gender or other demographic groups. Estimates of excess medical costs after quitting will provide tobacco control advocates with relevant information about the economic benefits of smoking cessation. Our results will provide implications for the HMOs in deciding what smoking cessation interventions to offer and will help illuminate the potential role of managed care organizations in implementing tobacco control interventions to reduce tobacco use and the associated economic burden.