4096.0: Tuesday, October 23, 2001 - 1:20 PM

Abstract #25809

A cost-benefit analysis of the Medicare Stop Smoking Program

Geoffrey F. Joyce, PhD1, Shin-Yi Wu, PhD2, Jeanette A. Preston, MD, MPH3, Laurence Z. Rubenstein, MD, MPH4, and Paul G. Shekelle, MD, PhD1. (1) RAND, 1700 Main Street, Santa Monica, CA 90407, 310-393-0411, gjoyce@rand.org, (2) Health, RAND, 1700 Main Street, Santa Monica, CA 90407, (3) Qualidigm, 100 Roscommon Road, Middletown, CT 06457, (4) Department of Veterans Affairs, VA Medical Center, 16111 Plummer St., North Hills, CA 91343

Background: Smoking cessation programs rarely target older adults. Yet older smokers are more likely to quit than younger smokers once enrolled in cessation programs and experience significant reductions in morbidity and mortality upon quitting. This paper estimates the potential effectiveness and cost savings of a new Medicare Stop Smoking Program, which aims to enroll 43,500 Medicare beneficiaries in 7 states. Methods: We compare the costs and cost-savings of usual care and 3 smoking cessation interventions: a telephone quitline with pharmacotherapy , provider counseling, and provider counseling plus pharmacotherapy. Using expenditure data from the Medicare Current Beneficiary Survey and estimates of quit rates, relapse, and changes in mortality risk from quitting, we estimate the reduction in Medicare reimbursements over 5 years due to lower rates of smoking-related illness and mortality. Sensitivity analyses are performed to assess the robustness of the findings. Results: The cost savings attributable to alternative smoking cessation treatments exceed total demonstration costs after 5 years. A telephone quitline with pharmacotherapy coverage is the most effective and cost-effective. While future Medicare outlays are reduced when smokers die early, the dramatic spike in medical expenses preceding death lead to substantial cost savings from quitting over intermediate time frames. Conclusions: Smoking cessation programs are widely viewed as the gold standard of healthcare cost-effectiveness. The cost of these programs may be offset by reductions in medical expenses even when targeting older smokers who accrue benefits over shorter time.

Learning Objectives: N/A

Keywords: Tobacco Control,

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 129th Annual Meeting of APHA