Healthcare Costs and Utilization of Smoking and Quitting

每年因烟草相关疾病、残疾和死亡造成的医疗费用和生产力损失估计超过1500亿美元。尽管烟草对卫生保健系统造成了明显的经济负担，并且有经证实的烟草依赖治疗方法，但美国的许多保险计划和健康计划并没有为这些治疗提供全面的好处。健康保险公司和医疗保健系统寻求投资戒烟治疗的“商业案例”。这项研究将为戒烟对吸烟者的医疗保健利用和成本的影响提供新的数据 戒烟和不戒烟在一个大型网络的初级保健诊所。该研究的一个独特之处是纵向检查在常规初级保健访问期间积极招募的吸烟者的医疗保健利用和成本，以接受药物治疗和心理社会戒烟治疗。这项研究的具体目标是：（1）从参与有效性研究的1320名吸烟者队列和通过电子病历审查确定的633名未被招募到治疗结果研究中的持续吸烟者样本中获得关于医疗保健利用的纵向数据，（2）使用有效性研究中长期戒烟者的戒烟日期作为参考点，比较保健 戒烟前两年和戒烟后三年半的有效性试验队列中戒烟者和持续吸烟者的利用率和成本，（3）使用长期戒烟者的戒烟日期作为参考点，比较有效性研究中戒烟者和持续吸烟者的医疗保健访问和诊断类型，（4）使用来自戒烟者（病例）和持续吸烟者（对照）的对照组的数据，建立戒烟者的医疗保健成本和利用率与其预测成本的模型，如果他们没有戒烟的话。

Annual costs resulting from medical expenses and lost productivity due to tobacco-related disease, disability, and death, areestimated at more than $150 billion. Despite the clear economic burden of tobacco on the health care system and the availability of proven treatments for tobacco dependence, many insurance programs and health plans in the United States do not offer a comprehensive benefit for these treatments. Health insurers and health care systems seek a 'business case' for investment in cessation treatment. This study wilt contribute new data on the impacts of cessation on health care utilization and costs of smokers quitting and not quitting within a large network of primary care clinics. A unique feature of the research is the longitudinal examination of health care utilization and costs for smokers actively recruited during routine primary care visits to receive pharmacotherapy and psychosocial cessation treatment. The specific aims of this study are to: (1) Obtain longitudinal data on health care utilization from the cohort of 1320 smokers participating in the Effectiveness study and from a sample of 633 continuing smokers identified through electronic medical record review who have not been recruited into a treatment-outcome study, (2) Using quit dates of protracted abstainers in the effectiveness study as reference points, compare health care utilization and costs among quitters and continuing smokers in the effectiveness trial cohort for two years prior to cessation and up to three and a half years post-cessation, (3) Using quit dates of protracted abstainers as reference points, compare types of health care visits and diagnoses among quitters and continuing smokers in the effectiveness study, and (4) Using data from the effectiveness study quitters (Cases) and the comparison group of patients who are continuing smokers (Controls), model the health care costs and utilization of quitters against their predicted costs had they not quit as determined from controls.