戒烟时的医疗保健费用。
Healthcare costs around the time of smoking cessation.
机构信息
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
出版信息
Am J Prev Med. 2012 Jun;42(6):596-601. doi: 10.1016/j.amepre.2012.02.019.
BACKGROUND
The Affordable Care Act mandates that new insurance plans cover smoking-cessation therapy without cost-sharing. Previous cost difference estimates, which show a spike around the time of cessation, suggest premiums might rise as a result of covering these services.
PURPOSE
The goal of the study was to test (1) whether individuals in an RCT of pharmacotherapy and counseling for smoking cessation differed in their healthcare costs around the cessation period, and (2) whether the healthcare costs of those in the trial who successfully quit were different from a matched sample of smokers in the community.
METHODS
Generalized linear regression models were used to analyze healthcare cost data on individuals enrolled in a comparative effectiveness trial of cessation therapies between October 2005 and May 2007 (1346 total participants; 1338 with requisite data for further analysis). Cost differences for the period preceding and subsequent to the cessation attempt were assessed by trial participants' 12-month sustained quit status. Healthcare cost differences between sustained quitters and a sample of community-dwelling smokers, matched to these quitters on the basis of health services use around the time trial participant enrolled and by demographics, were also examined. Data were analyzed in 2011.
RESULTS
All three groups had a spike in cost associated with the index clinic visit. Regression results revealed little difference in healthcare costs by quit status for trial participants until the sixth quarter post-quit. By that quarter, continuous sustained quitters cost $541 (p<0.001) less than continuing smokers. Continuous sustained quitters cost less than their matched community- dwelling smokers in almost every quarter observed. The cost difference ranged from $270 (p=0.01) during the quarter of quit, to $490 (p<0.01) in the 6th quarter after quitting.
CONCLUSIONS
The inclusion of smoking-cessation therapy does not appear to raise short-term healthcare costs. By the sixth quarter post-quit, sustained quitters were less costly than trial participants who continued smoking.
背景
平价医疗法案要求新的保险计划提供戒烟治疗，且不得分担费用。先前的成本差异估计显示，在戒烟期间会出现成本激增，这表明由于提供这些服务，保费可能会上涨。
目的
本研究的目的是检验：（1）在一项关于药物治疗和咨询戒烟的随机对照试验中，戒烟期间尝试戒烟的个体在医疗保健费用方面是否存在差异；（2）成功戒烟的试验参与者的医疗保健费用是否与社区中匹配的吸烟者样本有所不同。
方法
使用广义线性回归模型分析了 2005 年 10 月至 2007 年 5 月期间参加戒烟治疗比较效果试验的个体的医疗保健成本数据（共 1346 名参与者；1338 名参与者有进一步分析所需的数据）。通过试验参与者的 12 个月持续戒烟状态，评估戒烟尝试前后期间的成本差异。还检查了持续戒烟者与社区居住吸烟者样本之间的医疗保健成本差异，这些吸烟者根据试验参与者入组前后的健康服务使用情况以及人口统计学特征与这些戒烟者相匹配。数据分析于 2011 年进行。
结果
所有三组在索引诊所就诊时的成本都出现了飙升。回归结果显示，直到戒烟后的第六个季度，戒烟状态对试验参与者的医疗保健成本几乎没有差异。在那个季度，连续持续戒烟者的成本比持续吸烟者低 541 美元（p<0.001）。在观察到的几乎每一季度，连续持续戒烟者的成本都低于其匹配的社区居住吸烟者。成本差异从戒烟时的第 1 季度的 270 美元（p=0.01）到戒烟后第 6 季度的 490 美元（p<0.01）不等。
结论
纳入戒烟治疗似乎不会增加短期医疗保健成本。在戒烟后的第六个季度，持续戒烟者的成本低于继续吸烟的试验参与者。
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