Douglas E Levy1. 1. Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA. douglas_levy@post.harvard.edu
Abstract
OBJECTIVE: To investigate the costs and benefits of covering smoking cessation interventions from insurers' and employers' perspectives. STUDY DESIGN: A Monte Carlo model was used to simulate smoking status and health expenditures in a hypothetical population of employees over a period of 20 years. METHODS: Population characteristics were drawn from the 1997-2002 National Health Interview surveys. Multivariate regressions using a number of publicly available datasets from 1996-2002 generated transition probabilities for the simulation. The costs and benefits of scenarios where smoking cessation treatments were covered were compared with a scenario where none were covered. Sensitivity to parameter estimates was evaluated. RESULTS: By the final simulation year, insurers had benefit-cost ratios of 0.56 to 1.67 with per member per month costs of -$0.22 to $0.43. The earliest year at which savings were achieved for insurers was year 8. Employers saw benefit-cost ratios of 1.88 to 5.58 by the final simulation year with per member per month costs of -$1.23 to -$0.15. Employers achieved savings as early as year 3 and as late as year 8. Models were sensitive to the rate at which population members were assumed to exit the insurer or employer. CONCLUSION: Both insurers and employers may add smoking cessation benefits at minimal burden to their members and with potential savings, particularly where the population of interest is relatively stable.
OBJECTIVE: To investigate the costs and benefits of covering smoking cessation interventions from insurers' and employers' perspectives. STUDY DESIGN: A Monte Carlo model was used to simulate smoking status and health expenditures in a hypothetical population of employees over a period of 20 years. METHODS: Population characteristics were drawn from the 1997-2002 National Health Interview surveys. Multivariate regressions using a number of publicly available datasets from 1996-2002 generated transition probabilities for the simulation. The costs and benefits of scenarios where smoking cessation treatments were covered were compared with a scenario where none were covered. Sensitivity to parameter estimates was evaluated. RESULTS: By the final simulation year, insurers had benefit-cost ratios of 0.56 to 1.67 with per member per month costs of -$0.22 to $0.43. The earliest year at which savings were achieved for insurers was year 8. Employers saw benefit-cost ratios of 1.88 to 5.58 by the final simulation year with per member per month costs of -$1.23 to -$0.15. Employers achieved savings as early as year 3 and as late as year 8. Models were sensitive to the rate at which population members were assumed to exit the insurer or employer. CONCLUSION: Both insurers and employers may add smoking cessation benefits at minimal burden to their members and with potential savings, particularly where the population of interest is relatively stable.