A cost–benefit analysis of smoking cessation prescription coverage from a US payer perspective

• DOI: 10.2147/ceor.s165576
• Publication Date: 2018-07-15T23:44:11Z
• Authors: Christine Baker; Yao Ding; Cheryl Ferrufino; Stacey Kowal; Jingwen Tan; Prasun Subedi
• Keywords: Medicine (General); return on investment; cost-benefit analysis; 1. No poverty; RM1-950; Smoking cessation; 3. Good health; ClinicoEconomics and Outcomes Research; 03 medical and health sciences; smoking-attributable medical expenditures; R5-920; 0302 clinical medicine; Therapeutics. Pharmacology; Original Research

Smoking drives substantial direct health care spending, comprising 8.7% ($168 billion) of annual United States aggregated spending. cessation (SC) prescription use is an effective strategy to improve outcomes, increase quit rates, and reduce economic burden. However, patient out-of-pocket costs may limit the use. Health payers play a vital role in driving through formulary decisions copayment policies but must consider both near-term financial investment as well downstream effects increased coverage on budgets. This study estimates return (ROI) providing Affordable Care Act (ACA)-recommended SC coverage.A cost-benefit analysis (CBA) ROI coverage, based pharmacy savings from smoking-attributable medical expenditures among Medicare, Medicaid, commercial plan enrollees over 10 years. The CBA incorporated national-level population demographics, smoking prevalence estimates, proportion smokers attempting quit, utilization products. A five-state Markov chain model simulated patterns attempts, relapse, assuming two attempts per year, no cost-sharing, 25.4% aids. Results include number quitters, costs, ROI.After initial treatment, benefits accrue time, generating positive by year 4 for (11.3%) Medicaid (78.4%) plans 3 Medicare (30.6%). Over years, average $1.18, $2.50, $3.22 dollar spent prescriptions commercial, plans, respectively, be realized.Given proven efficacy pharmacotherapy, investments supporting ACA-recommended translate into ROI. As leading cause morbidity mortality, access medications outcomes time.