Cigarette smoking is one of the greatest drivers of adverse health outcomes and costs for state Medicaid programs. Yet, while 70 percent of U.S. smokers report that they want to quit, few who try to quit use evidence-based treatments that can significantly increase their odds of success.
States can reduce smoking rates and health care costs and improve health outcomes by investing in comprehensive smoking cessation programs. Tobacco dependence treatment is one of the most cost-effective preventive services, providing substantial return on investment in both the short and long term.
The "cost per quit" of smoking cessation interventions ranges from a few hundred to a few thousand dollars, while the average cost for treating a single case of lung cancer can be over $40,000. A study published in 2012 by Hockenberry, et al. shows that tobacco cessation treatment in the outpatient setting lowers health care costs within 18 months of quitting. The study found that 18 months after their quit date, continuous sustained quitters cost $541 less per quarter than those who continued smoking. Another study found that the expenditures for smoking cessation programs could be offset by health care cost savings within 3 years.
Massachusetts - Produces High Return on Investment
Massachusetts recently implemented a highly effective smoking cessation program including a medical cessation benefit that:
- Is based on powerful evidence: the 2008 United States Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, known as "The PHS Guideline"
- Is designed to remove barriers to access and encourage benefit utilization by providing broad coverage for evidence-based tobacco cessation treatments under Medicaid
- Includes an innovative service delivery component-a widespread communications and promotional campaign directed at both Medicaid consumers and clinicians.
Over the first two and a half years of the Massachusetts program:
- 37 percent of Massachusetts Medicaid enrollees who smoked utilized the benefit; and
- The prevalence of smoking among adult Medicaid members in Massachusetts fell from 38 percent to 28 percent.
Reports on health outcomes showed:
- A 46 percent decline in hospitalizations for heart attacks;
- A 49 percent decline in hospitalizations for other acute coronary heart disease diagnoses; and
- For every dollar expended on the program, there was a $2.12 return on investment within 3 years.
- Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
- Greene J, Sacks RM, McMenamin SB. The Impact of Tobacco Dependence Treatment Coverage and Copayments in Medicaid (PDF, 114.53 KB). American Journal of Preventive Medicine. April 2014.
- Hockenberry, J, Curry S, Fishman P Baker T, Fraser, Cisler R,Jackson T, Fiore, M. Healthcare Costs Around the Time of Smoking Cessation. Am J Prev Med 2012;42(6):596-601
- Kutikova L, Bowman L, Chang S, Long S, Obasaju C, Crown WH. (2005) The Economic Burden of Lunch Cancer and the Associated Costs of Treatment Failure in the United States. Lung Cancer 2005: 50(2): 143-154
- Land T, Warner D, Paskowsky M, Cammaerts A, Wetherell L, et al. (2010) Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Smoking Prevalence. PLoS ONE 5(3): e9770 .
- Making the Business Case for Smoking Cessation Programs: 2012 Update” A report by Leif Associates
- Richard P, West K, Ku L (2012) The Return on Investment of a Medicaid Tobacco Cessation Program in Massachusetts. PLoS ONE 7(1): e29665
- Warren JL, Yabroff KR, Meekins A, Topor M, Lamont EB, Brown ML. Evaluation of Trends in the Cost of Initial Cancer Treatment. J Natl Cancer Inst 2008;100: 888-897