Out of my email inbox’s daily deluge of medical journal push notifications and study updates, an article recently stood out. It outlined a study recently completed by Dr. Tami Gurley-Calvez and Jessica Sand at the University of Kansas School of Medicine to determine the cost-effectiveness of smoking cessation services. The study was commissioned by NAMI, the National Alliance on Mental Illness, with funding from the Kansas Health Foundation.
Increasing coverage for more quit attempts
A single “quit attempt” is defined as four sessions of counseling and 90 days of any single FDA-approved smoking cessation medications like nicotine replacement, varenicline, or bupropion. The investigators compared the costs to payers of continuing to cover two quit attempts per year (eight sessions of counseling and 180 days of medication, as currently mandated by the Affordable Care Act), versus increasing coverage to 4 quit attempts per year, equaling sixteen sessions of counseling and potentially a full year’s coverage of a medication. Costs were the sum of the cost of the counseling sessions and medication costs. Benefits were the projected reduction in medical spending attributed to a reduction in the number of smokers. The investigators assumed a 4.4% relapse rate in people who had quit smoking for more than a year.
For smokers under the age of 65, either model–two quit attempts or four quit attempts–broke even by year four; that is, money paid for counseling and medications was equaled by reduced medical spending. But by year six, the cost-savings of the additional counseling sessions and additional medication coverage really took off:
By year 10, the per-person benefit of covering four quit attempts per year–$215–was almost double that of two quit attempts, at $109. This is to say that your return on investment for paying for additional smoking cessation services appears to roughly double when you double the up-front investment in counseling services and drug coverage.
If you feel a little leery about modeling studies right now, considering the difficulty epidemiologists have had in modeling responses to COVID-19 interventions, know that the conclusions of this study in terms of quit rates are well-established by clinical trials in real people.
We should always be careful about acting on the results of a single study. But there is a strong signal here that, if your company currently covers the ACA-minimum two quit attempts per year, you may benefit financially from increasing coverage to four quit attempts per year. Dr. Gurley-Calvez and Ms. Sand rightly point out that some companies may not expect to keep employees for the five to six years needed to reach net economic benefit. But they also note, as we’ve long pointed out to KBGH members, that if this type of coverage were applied uniformly across a number of diverse companies, we could collectively achieve these economic benefits alongside a healthier employee population, even if the members of that population changed jobs frequently.
If you have strategies your company has used in smoking cessation or substance abuse that you’ve found successful, please share them with us!
As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on topics that might affect employers or employees. This was a reprint of a blog post from KBGH.