Advocates for Evidence-Based Health Policy Speakers
Medication with Counseling to Stop Smoking
If asked to name the leading cause of preventable death in the United States, you could probably guess the answer. After decades of public health campaigns, nearly everyone knows that smoking is bad for you. But it still kills nearly half a million people every year. In terms of fiscal impact, health care costs for smoking-attributable diseases represent almost 9% of U.S. healthcare spending or $170 billion each year. Public programs shoulder a disproportionate share of that burden with Medicaid devoting 15% (~$40 billion) of its annual spending to smoking-related illness. I’ve previously written about the importance of focusing on “where the money is.” Smoking qualifies.
Therefore, figuring out how to help people stop smoking is important for public policy. One approach is to offer coverage for smoking cessation treatments through public programs such as Medicaid. Across the nation, a dizzying array of types of coverage (medication only, counseling only, both) are offered by various states. Previous research into what is most effective has turned up mixed results. Furthermore, past research has largely compared quitting rates between states and may be confounded by state-level factors. This study takes a national approach but includes comparisons within states to provide the best estimate to date of the effect of smoking cessation treatment coverage on quit rates.
The study found that combined coverage of cessation counseling and medication increased the absolute quit rate by 3.0 percentage points (a 33% increase from average past-year quit rates). Covering counseling or medication alone did not have a significant effect on quit rates. Interestingly, when the income cutoff for the low-income comparison group was raised from 150% to 250% of the federal poverty level, the impact of cessation treatment coverage dropped, suggesting that coverage may be particularly important in the lowest income populations.
Thus, states that currently only cover medication or counseling treatment should move to making them available in tandem, a recommendation by the U.S. Preventive Services Task Force that is borne out by this study. Moreover, these findings provide yet another reason for states to expand Medicaid, as making combined cessation treatment more readily available has been clearly shown to decrease smoking.
Abstract
OBJECTIVE: Cigarette smoking and smoking-related diseases disproportionately affect low-income populations. Health insurance coverage of smoking cessation treatments is increasingly used to encourage quitting. We assess the relationship between state Medicaid coverage of smoking cessation treatments and past-year quitting in adult Medicaid beneficiaries.
DATA SOURCES: 2009-2014 National Health Interview Survey (NHIS); 2008-2013 indicators of state Medicaid coverage of smoking cessation treatments.
STUDY DESIGN: A triple-differencing specification based on differences in Medicaid cessation coverage policies across states as well as within-state differences between Medicaid beneficiaries and a counterfactual group of low-income adults not covered by Medicaid.
DATA COLLECTION/EXTRACTION METHODS: Individual-level NHIS data with restricted geographical identifiers were merged with state-year Medicaid coverage indicators.
PRINCIPAL FINDINGS: Combined coverage of both cessation counseling and medications in state Medicaid programs was associated with increased quitting, with an estimated mean increase in past-year quitting of 3.0 percentage points in covered Medicaid beneficiaries relative to persons without coverage.
CONCLUSIONS: Combined coverage of both smoking cessation counseling and medication by state Medicaid programs could help reduce cigarette smoking among Medicaid beneficiaries.
PMID: 29806177
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