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Shrestha SS, Xu X, Wang X, Babb SD, Armour BS, King BA, Trivers KF. Receipt of and Spending on Cessation Medication Among US Adults With Employer-Sponsored Health Insurance, 2010 and 2017. Public Health Rep 2021; 136:736-744. [PMID: 33601983 DOI: 10.1177/0033354920984155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Studies examining the use of smoking cessation treatment and related spending among enrollees with employer-sponsored health insurance are dated and limited in scope. We assessed changes in annual receipt of and spending on cessation medications approved by the US Food and Drug Administration (FDA) among tobacco users with employer-sponsored health insurance from 2010 to 2017. METHODS We analyzed data on 439 865 adult tobacco users in 2010 and 344 567 adult tobacco users in 2017 from the IBM MarketScan Commercial Database. We used a negative binomial regression to estimate changes in receipt of cessation medication (number of fills and refills and days of supply). We used a generalized linear model to estimate spending (total, employers', and out of pocket). In both models, covariates included year, age, sex, residence, and type of health insurance plan. RESULTS From 2010 to 2017, the percentage of adult tobacco users with employer-sponsored health insurance who received any cessation medication increased by 2.4%, from 15.7% to 16.1% (P < .001). Annual average number of fills and refills per user increased by 15.1%, from 2.5 to 2.9 (P < .001) and days of supply increased by 26.4%, from 81.9 to 103.5 (P < .001). The total annual average spending per user increased by 53.6%, from $286.40 to $440.00 (P < .001). Annual average out-of-pocket spending per user decreased by 70.9%, from $70.80 to $20.60 (P < .001). CONCLUSIONS Use of smoking cessation medications is low among smokers covered by employer-sponsored health insurance. Opportunities exist to further increase the use of cessation medications by promoting the use of evidence-based cessation treatments and reducing barriers to coverage, including out-of-pocket costs.
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Affiliation(s)
- Sundar S Shrestha
- 1242 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Xu
- 1242 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xu Wang
- 1242 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen D Babb
- 1242 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian S Armour
- 1242 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian A King
- 1242 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katrina F Trivers
- 1242 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Leung N, Bernacki SE, Bernacki EJ. A Success Story: Advances in Treatment and Lower Disease Prevalence of Hepatitis C Has a Large Impact on Medical Plan Costs. J Occup Environ Med 2020; 61:e354-e357. [PMID: 31205208 DOI: 10.1097/jom.0000000000001633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate medical and pharmaceutical costs and health outcomes among commercially insured members treated for hepatitis C virus (HCV) infections from a large, academic institution. METHODS Data are derived from the University of Texas System (UT SELECT) medical and pharmacy claims database. This study is a retrospective claims analysis of secondary, deidentified data from 2006 to 2016. RESULTS The number of HCV-infected and treated patients decreased from 22.5 per 10,000 members in 2006 to 0.15 per 10,000 members in 2016 (P < 0.0001). Medical and pharmacy paid per member per month (PMPM) costs were highest among HCV-infected members with advanced liver disease (total paid PMPM = $2737, medical PMPM = $1537, pharmacy PMPM = $1200). CONCLUSIONS The declining prevalence of acute HCV infections and the introduction of efficacious HCV treatment options for chronic HCV in this commercial population have resulted in significant reductions in HCV-related medical claims and the clinical sequelae of advanced liver diseases. Although HCV treatment to achieve sustained viral response remains expensive, the prevention of advanced liver disease decreased system-wide medical costs for this insured population.
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Affiliation(s)
- Nina Leung
- Dell Medical School, The University of Texas at Austin, Austin, Texas; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (Dr Leung and Dr Bernacki); University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas (Mr Bernacki)
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Králíková E, Pánková A. Barriers to introduction of smoke-free workplaces in Central Europe: example of the Czech Republic. Cent Eur J Public Health 2020; 28 Suppl:S22-S25. [PMID: 33069177 DOI: 10.21101/cejph.a6160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/26/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Smoking at the workplace has a negative impact both on employers' economic interests and employees' health. The aim of this study is to describe the current situation, mainly barriers in implementation and resources in the Czech Republic as an example of a Central European country. METHODS We synthesised relevant review papers with our knowledge of the local situation based upon professional experience of both authors. RESULTS Despite smoke-free laws, some EU workers are still exposed to passive smoking during working hours. The main barriers towards smoke-free workplace implementation are the lack of resources, perception of smoking as a norm, and exceptions for leading personalities and their smoking. Social support increases smoking cessation effectiveness. Low availability of local smoking cessation services is an overall problem in Central Europe. CONCLUSIONS The working environment influences smoking habits. Smoking cessation support is cost-effective not only for the smoking employee but for employers as well. Smoking cessation resources should be available during the working day. No exceptions should be made as they serve as barriers to a smoke-free working environment.
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Affiliation(s)
- Eva Králíková
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Centre for Tobacco Dependence, Third Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Alexandra Pánková
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Centre for Tobacco Dependence, Third Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Menzin J, Lines LM, Marton J. Estimating the short-term clinical and economic benefits of smoking cessation: do we have it right? Expert Rev Pharmacoecon Outcomes Res 2014; 9:257-64. [DOI: 10.1586/erp.09.28] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Galaznik A, Cappell K, Montejano L, Makinson G, Zou KH, Lenhart G. Impact of access restrictions on varenicline utilization. Expert Rev Pharmacoecon Outcomes Res 2013; 13:651-6. [PMID: 24138649 DOI: 10.1586/14737167.2013.837770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM To assess the impact of access restrictions on varenicline utilization. METHODS Employer-sponsored health plans contributing to the MarketScan Commercial Claims and Encounters Database were categorized according to 2009 varenicline access restrictions: no coverage; prior authorization; smoking cessation program requirement; no restrictions. The cohort comprised all adults continuously enrolled in plans during 2009. Each restriction cohort was compared with the no restrictions cohort using descriptive analyses. Data were assessed using logistic regression; demographic and clinical characteristics were covariates. RESULTS In this study (no coverage, n = 454,419; prior authorization, n = 171,530; smoking cessation program, n = 108,181; no restrictions, n = 607,389), compared with the no restrictions cohort, the odds of treatment were 71% lower (odds ratio: 0.29; 95% CI: 0.26, 0.31) in the smoking cessation program cohort (p < 0.001) and 80% lower (odds ratio: 0.20; 95% CI: 0.19, 0.22) in the prior authorization cohort (p < 0.001). CONCLUSIONS Access restrictions were associated with significantly lower odds for varenicline utilization.
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La acreditación de las Unidades Especializadas en Tabaquismo. Arch Bronconeumol 2011; 47:59-60. [DOI: 10.1016/j.arbres.2010.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 09/04/2010] [Indexed: 11/18/2022]
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Kobus K, Mermelstein R. Bridging basic and clinical science with policy studies: The Partners with Transdisciplinary Tobacco Use Research Centers experience. Nicotine Tob Res 2009; 11:467-74. [PMID: 19346504 DOI: 10.1093/ntr/ntp040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The Partners with Transdisciplinary Tobacco Use Research Centers (TTURCs) initiative was a transdisciplinary team-building program, funded by the Robert Wood Johnson Foundation, to expand the policy research capacity of the TTURCs. EXPANSION INTO POLICY RESEARCh: Policy research activities at the TTURCs fell into four broad domains: (a) health services research, (b) examination of the business case for cessation treatment and funding, (c) collaborative teams with key stakeholders, and (d) direct assessment of smoking-related policies. Examples of each domain are presented. OUTCOMES Goals of the initiative included efforts to foster collaborative, transdisciplinary research, to bring new investigators into the field, to develop programs of policy research, to answer next-step translational questions, and to enhance awareness of policy relevance. Success at meeting each of these goals is discussed. RECOMMENDATIONS We offer recommendations for incorporating programs of policy research into full-spectrum transdisciplinary research initiatives, including the roles of research teams, senior researchers, infrastructure, stakeholders, and communications activities. CONCLUSIONS The TTURC Partners initiative represented a first-generation effort to fill the gap between scientific discovery and research translation through expansion into policy studies. While all aspects of the effort were not equally successful, the effort demonstrated that it is possible to develop successful collaborations that extend more basic and applied research into studies that examine their policy and practice implications.
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Affiliation(s)
- Kimberly Kobus
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558, M/C 275, Chicago, IL 60608, USA.
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Gollust SE, Schroeder SA, Warner KE. Helping smokers quit: understanding the barriers to utilization of smoking cessation services. Milbank Q 2009; 86:601-27. [PMID: 19120982 DOI: 10.1111/j.1468-0009.2008.00536.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Counseling smokers to quit smoking and providing them with pharmaceutical cessation aides are among the most beneficial and cost-effective interventions that clinicians can offer patients. Yet assistance with quitting is not universally covered by health plans or offered by all clinicians. Analysis of stakeholders' perspectives and interests can identify the barriers to more widespread provision of cessation services and suggest strategies for the public policy agenda to advance smoking cessation. METHODS Review of literature and discussions with representatives of stakeholders. FINDINGS All stakeholders-health plans, employers, clinicians, smokers, and the government-face barriers to broader smoking cessation activities. These range from health plans' perceiving that covering counseling and pharmacotherapy will increase costs without producing commensurate health care savings, to clinicians' feeling unprepared and uncompensated for counseling. Like other preventive measures aimed at behavior, efforts directed at smoking cessation have marginal status among health care interventions. State governments can help correct this status by increasing Medicaid coverage of treatment and expanding coverage for state employees. The federal government can promote the adoption of six initiatives recommended by a government subcommittee on cessation: set up a national quit line, develop a media campaign to encourage cessation, include cessation benefits in all federally funded insurance plans, create a research infrastructure to improve cessation rates, develop a clinician training agenda, and create a fund to increase cessation activities through a new $2 per pack cigarette excise tax. Both the federal and state governments can increase cessation by adopting policies such as the higher cigarette tax and laws prohibiting smoking in workplaces and public places. CONCLUSIONS Public policy efforts should assume greater social responsibility for smoking cessation, including more aggressive leadership at the state and federal levels, as well as through advocacy, public health, and clinician organizations.
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A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med 2008; 35:158-76. [PMID: 18617085 PMCID: PMC4465757 DOI: 10.1016/j.amepre.2008.04.009] [Citation(s) in RCA: 782] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 04/16/2008] [Accepted: 04/17/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To summarize the U.S. Public Health Service guideline Treating Tobacco Use and Dependence: 2008 Update, which provides recommendations for clinical interventions and system changes to promote the treatment of tobacco dependence. PARTICIPANTS An independent panel of 24 scientists and clinicians selected by the U.S. Agency for Healthcare Research and Quality on behalf of the U.S. Public Health Service. A consortium of eight governmental and nonprofit organizations sponsored the update. EVIDENCE Approximately 8700 English-language, peer-reviewed articles and abstracts, published between 1975 and 2007, were reviewed for data that addressed assessment and treatment of tobacco dependence. This literature served as the basis for more than 35 meta-analyses. CONSENSUS PROCESS Two panel meetings and numerous conference calls and staff meetings were held to evaluate meta-analyses and relevant literature, to synthesize the results, and to develop recommendations. The updated guideline was then externally reviewed by more than 90 experts, made available for public comment, and revised. CONCLUSIONS This evidence-based, updated guideline provides specific recommendations regarding brief and intensive tobacco-cessation interventions as well as system-level changes designed to promote the assessment and treatment of tobacco use. Brief clinical approaches for patients willing and unwilling to quit are described.
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Curry SJ, Keller PA, Orleans CT, Fiore MC. The role of health care systems in increased tobacco cessation. Annu Rev Public Health 2008; 29:411-28. [PMID: 18173387 DOI: 10.1146/annurev.publhealth.29.020907.090934] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Health care delivery systems are critical components of tobacco cessation efforts. This review summarizes recent evidence in support of the health care system recommendations in the 2000 U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence. Measurable progress in addressing tobacco use through the health care system is summarized, including accountabilities for addressing tobacco in national health care reporting systems, increases in reported advice to quit smoking from health care providers, and wider availability of insurance coverage for tobacco cessation treatments. Despite progress, significant gaps remain between what is possible and what is done by health care systems to impact tobacco cessation. A four-point public policy agenda is outlined to help close these gaps.
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Affiliation(s)
- Susan J Curry
- Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA.
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