Department of Health Policy, School of Public Health and Health Services, The George Washington University, Washington, District of Columbia, United States of America.
PLoS One. 2012;7(1):e29665. doi: 10.1371/journal.pone.0029665. Epub 2012 Jan 6.
A high proportion of low-income people insured by the Medicaid program smoke. Earlier research concerning a comprehensive tobacco cessation program implemented by the state of Massachusetts indicated that it was successful in reducing smoking prevalence and those who received tobacco cessation benefits had lower rates of in-patient admissions for cardiovascular conditions, including acute myocardial infarction, coronary atherosclerosis and non-specific chest pain. This study estimates the costs of the tobacco cessation benefit and the short-term Medicaid savings attributable to the aversion of inpatient hospitalization for cardiovascular conditions.
A cost-benefit analysis approach was used to estimate the program's return on investment. Administrative data were used to compute annual cost per participant. Data from the 2002-2008 Medical Expenditure Panel Survey and from the Behavioral Risk Factor Surveillance Surveys were used to estimate the costs of hospital inpatient admissions by Medicaid smokers. These were combined with earlier estimates of the rate of reduction in cardiovascular hospital admissions attributable to the tobacco cessation program to calculate the return on investment.
Administrative data indicated that program costs including pharmacotherapy, counseling and outreach costs about $183 per program participant (2010 $). We estimated inpatient savings per participant of $571 (range $549 to $583). Every $1 in program costs was associated with $3.12 (range $3.00 to $3.25) in medical savings, for a $2.12 (range $2.00 to $2.25) return on investment to the Medicaid program for every dollar spent.
These results suggest that an investment in comprehensive tobacco cessation services may result in substantial savings for Medicaid programs. Further federal and state policy actions to promote and cover comprehensive tobacco cessation services in Medicaid may be a cost-effective approach to improve health outcomes for low-income populations.
有相当比例的参加“医疗补助计划”（Medicaid program）的低收入人群吸烟。此前，有关马萨诸塞州实施的一项综合性戒烟计划的研究表明，该计划成功降低了吸烟率，而且接受戒烟福利的人因心血管疾病（包括急性心肌梗死、冠状动脉粥样硬化和非特异性胸痛）住院的比例较低。本研究估算了戒烟福利的成本以及因避免心血管疾病住院治疗而节省的短期医疗补助支出。
采用成本效益分析方法估算该计划的投资回报率。利用行政数据计算每位参与者的年度成本。利用 2002-2008 年医疗支出面板调查和行为风险因素监测调查的数据，估算医疗补助吸烟者的住院费用。结合先前估计的因戒烟计划而减少心血管疾病住院治疗的比例，计算投资回报率。
行政数据显示，包括药物治疗、咨询和外展费用在内，该计划每位参与者的费用约为 183 美元（2010 年）。我们估计每位参与者的住院费用节省为 571 美元（范围为 549 美元至 583 美元）。每 1 美元的计划成本与 3.12 美元（范围为 3.00 美元至 3.25 美元）的医疗储蓄相关，即每 1 美元的投资回报率为 2.12 美元（范围为 2.00 美元至 2.25 美元），对医疗补助计划而言是一种有成本效益的投资。
这些结果表明，对综合性戒烟服务进行投资可能会为医疗补助计划节省大量资金。联邦和州进一步采取政策行动，在医疗补助计划中推广和涵盖综合性戒烟服务，可能是改善低收入人群健康结果的一种具有成本效益的方法。
