Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization
Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization
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DOI：
10.1056/nejm199809033391006
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发表时间：
1998-09-03
影响因子：
158.5
通讯作者：
Pabiniak, C
中科院分区：
文献类型：
--
作者：
Curry, SJ;Grothaus, LC;Pabiniak, C
背景对戒烟服务的需求和使用的保险范围的缺乏的信息阻碍了对这类服务的保险的广泛采用。方法在一个纵向、自然的实验中，我们比较了三种形式的保险的使用和成本效益与标准形式的戒烟服务的使用和成本效益，包括行为计划和尼古丁替代疗法。这项研究涉及七个雇主和总共9万名成年参与者。标准计划提供了50%的行为计划和尼古丁替代疗法的全覆盖。其他计划提供了行为计划和尼古丁替代疗法的50%覆盖(减少覆盖)，行为计划和尼古丁替代疗法的50%覆盖(翻转覆盖)，或行为计划和尼古丁替代疗法的全覆盖。结果估计戒烟服务的年使用率从2.4%(在覆盖减少的吸烟者中)到10%(在全覆盖的吸烟者中)。戒烟率从28%(在完全覆盖的用户中)到38%(在标准覆盖的用户中)不等。每年因使用这些服务而戒烟的所有吸烟者的估计百分比从0.7%(覆盖率降低)到2.8%(全覆盖)不等。每个戒烟用户的健康计划的平均成本从797美元(标准覆盖)到1171美元(全覆盖)不等。每个吸烟者的年成本从6美元(缩小覆盖范围)到33美元(完全覆盖)不等。每个参与者的年成本从0.89美元(缩小覆盖范围)到4.92美元(全覆盖)。结论戒烟服务的使用因覆盖范围的不同而不同，全覆盖吸烟者的使用率最高。尽管完全覆盖的受益使用者的戒烟率低于需要共同支付计划的使用者的戒烟率，但全覆盖对总体吸烟率的影响大于费用分摊计划。(N Engl J Med 1998；339：673-9)(C)1998年，马萨诸塞州医学会。
Background Lack of information about the effect of insurance coverage on the demand for and use of smoking-cessation services has prevented widescale adoption of coverage for such services.Methods In a longitudinal, natural experiment, we compared the use and cost effectiveness of three forms of coverage with those of a standard form of coverage for smoking-cessation services that included a behavioral program and nicotine-replacement therapy. The study involved seven employers and a total of 90,005 adult enrollees. The standard plan offered 50 percent coverage of the behavioral program and full coverage of nicotine-replacement therapy. The other plans offered 50 percent coverage of both the behavioral program and nicotine-replacement therapy (reduced coverage), full coverage of the behavioral program and 50 percent coverage of nicotine-replacement therapy (flipped coverage), or full coverage of both the behavioral program and nicotine-replacement therapy.Results Estimated annual rates of use of smoking-cessation services ranged from 2.4 percent (among smokers with reduced coverage) to 10 percent (among those with full coverage). Smoking-cessation rates ranged from 28 percent (among users with full coverage) to 38 percent (among those with standard coverage). The estimated percentage of all smokers who would quit smoking per year as a result of using the services ranged from 0.7 percent (with reduced coverage) to 2.8 percent (with full coverage). The average cost to the health plan per user who quit smoking ranged from $797 (with standard coverage) to $1,171 (with full coverage). The annual cost per smoker ranged from $6 (with reduced coverage) to $33 (with full coverage). The annual cost per enrollee ranged from $0.89 (with reduced coverage) to $4.92 (with full coverage).Conclusions Use of smoking-cessation services varies according to the extent of coverage, with the highest rates of use among smokers with full coverage. Although the rate of smoking cessation among the benefit users with full coverage was lower than the rates among users with plans requiring copayments, the effect on the overall prevalence of smoking was greater with full coverage than with the cost-sharing plans. (N Engl J Med 1998;339:673-9.) (C)1998, Massachusetts Medical Society.