Insurance incentives might help smokers quit, study says

Health insurance that pays the full cost of smoking-cessation treatments can increase quit rates, compared to benefit plans that pick up only part of the tab or that offer no cessation benefits at all, according to a new review of studies.

Smokers receiving full benefits were one-and-a-half times more likely to quit successfully and nearly one-and-a-half times more likely to try quitting than those receiving no benefit, according to review authors Janneke Kaper of Maastricht University in the Netherlands and colleagues.

The actual increase in quit rates was slight, however. In studies where a full benefit was compared to no benefit, abstinence rates among smokers rose 2 percentage points, Kaper says. “In this economically minded time, determining the effectiveness of an intervention is no longer enough to justify its use,” Kaper says. “As health care costs increase and resources are limited, it is also important to determine whether financial support for smoking-cessation treatment is cost-effective.”

The “relatively low costs” of providing full benefits for smoking cessation varied between $260 and $2,330 per quitter, compared to partial or no benefits, the researchers say.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Previous research shows that smoking-cessation treatment, including counseling, nicotine replacement products and the antidepressant drug bupropion can increase the chances that a smoker will give up the habit.

But “costs are a significant barrier to the use of smoking-cessation treatment. Healthcare providers may be deterred from offering treatment if they do not receive reimbursement, and patients may be deterred if they must pay for treatment costs,” Kaper says.

Kaper and colleagues reviewed evidence from six high-quality studies of financial incentives directed at smokers and one study that looked at the effects of incentives paid to clinics that actively identified smokers and documented advice to quit.

Incentives such as full insurance coverage for smoking-cessation therapies slightly improved quit rates, the studies showed, but the payments to clinics did not improve quit rates significantly.

There were also no signs that the incentives had caused the clinics to change their usual advice and care for smokers. Studies of financial incentives directed at health care providers are almost non-existent “probably because there are simply no such incentive systems,” Kaper says.

“Governments and health insurance companies try to control medical expenditures. Rewarding health care providers for increasing their number of prescriptions may contradict their policy,” she suggests.

Some health care system managers have suggested that “removing financial barriers to treatment would lead to less motivated smokers using treatment services, such that quit rates would go down,” according to smoking cessation researcher Sue Curry.

In light of this, “the finding in the review that full financial benefits actually increased cessation rates is quite encouraging,” says Curry, who is the director of the Institute for Health Research and Policy at the University of Illinois at Chicago.

Kaper says the review’s findings should be interpreted with caution because the studies varied significantly in the people, places and health care systems that were examined.

Although Kaper and colleagues suggest that financial support can increase the proportion of smokers who use quit therapies, Curry says history may suggest otherwise, in that mammography screening rates, for example, continue to lag even after most insurance began to cover the procedure, Curry says.

“I would focus future research on ways of increasing use of treatment, given full coverage,” Curry says.