Massachusetts Tobacco Cessation and Prevention Program, Boston, Massachusetts, United States of America.
PLoS Med. 2010 Dec 7;7(12):e1000375. doi: 10.1371/journal.pmed.1000375.
Insurance coverage of tobacco cessation medications increases their use and reduces smoking prevalence in a population. However, uncertainty about the impact of this coverage on health care utilization and costs is a barrier to the broader adoption of this policy, especially by publicly funded state Medicaid insurance programs. Whether a publicly funded tobacco cessation benefit leads to decreased medical claims for tobacco-related diseases has not been studied. We examined the experience of Massachusetts, whose Medicaid program adopted comprehensive coverage of tobacco cessation medications in July 2006. Over 75,000 Medicaid subscribers used the benefit in the first 2.5 years. On the basis of earlier secondary survey work, it was estimated that smoking prevalence declined among subscribers by 10% during this period.
Using claims data, we compared the probability of hospitalization prior to use of the tobacco cessation pharmacotherapy benefit with the probability of hospitalization after benefit use among Massachusetts Medicaid beneficiaries, adjusting for demographics, comorbidities, seasonality, influenza cases, and the implementation of the statewide smoke-free air law using generalized estimating equations. Statistically significant annualized declines of 46% (95% confidence interval 2%-70%) and 49% (95% confidence interval 6%-72%) were observed in hospital admissions for acute myocardial infarction and other acute coronary heart disease diagnoses, respectively. There were no significant decreases in hospitalizations rates for respiratory diagnoses or seven other diagnostic groups evaluated.
Among Massachusetts Medicaid subscribers, use of a comprehensive tobacco cessation pharmacotherapy benefit was associated with a significant decrease in claims for hospitalizations for acute myocardial infarction and acute coronary heart disease, but no significant change in hospital claims for other diagnoses. For low-income smokers, removing the barriers to the use of smoking cessation pharmacotherapy has the potential to decrease short-term utilization of hospital services.
医疗保险覆盖范围的扩大增加了戒烟药物的使用，并降低了人群中的吸烟率。然而，对于这种覆盖范围对医疗保健利用和成本的影响的不确定性是该政策更广泛采用的障碍，特别是对于由公共资金资助的州医疗补助保险计划而言。由公共资金资助的戒烟福利是否会导致与烟草相关的疾病的医疗索赔减少尚未得到研究。我们研究了马萨诸塞州的经验，该州的医疗补助计划于 2006 年 7 月采取了全面的戒烟药物覆盖范围。在最初的 2.5 年中，超过 75,000 名医疗补助计划的订阅者使用了该福利。根据早期的二次调查工作，据估计在此期间，订阅者的吸烟率下降了 10％。
使用索赔数据，我们比较了在使用戒烟药物治疗福利之前和之后，马萨诸塞州医疗补助受益人的住院概率，调整了人口统计学，合并症，季节性，流感病例以及全州范围内的禁烟法的实施情况，使用广义估计方程。分别观察到急性心肌梗死和其他急性冠状动脉心脏病诊断的住院率的年化下降率分别为 46％（95％置信区间 2％-70％）和 49％（95％置信区间 6％-72％）。对于呼吸道疾病或评估的其他七个诊断组，住院率没有明显下降。
在马萨诸塞州医疗补助计划的订户中，全面使用戒烟药物治疗福利与急性心肌梗死和急性冠状动脉心脏病住院索赔的显著减少有关，但其他诊断的住院索赔没有明显变化。对于低收入吸烟者而言，消除戒烟药物使用的障碍有可能减少短期住院服务的利用。
