The 13th World Conference on Tobacco OR Health

Objective: The lack of data on the net financial returns from smoking cessation is an important barrier for health plans interested in interventions. We addressed this problem by estimating the 3–5 year return on investment (ROI) to health system efforts to reduce smoking.

Methods: We used a probabilistic cohort model to estimate the net financial impacts of four 5 A's-based cessation programs (including medications and telephone counseling) compared to usual care (2 A's). Using published reach, efficacy, and intervention cost data, we estimated the incremental ROI of a one-year program. We projected patterns of smoking, disease, plan eligibility, and medical expenditures and productivity losses for smokers and quitters annually over five years. We predicted changes in smoking status, smoking-related disease incidence, and plan disenrollment using multivariate regression analyses of the electronic medical records data for nearly 190,000 HMO members from 1997 to 2002. Separate estimates were calculated for heavy and light smokers, and by age and sex. We used generalized linear models to estimate mean annual medical care expenditures for each group with similar disease, smoking, and eligibility enrollment patterns. Productivity savings were estimated using published data.

Results: Health plan investments of $.18–$.79 per member per month (PMPM) were found to generate an incremental net ROI of $1.34–$2.05 PMPM after five years compared to usual care. Employers saved $.19–$.35 PMPM at five years. Sensitivity analyses did not change these conclusions. These results are the first evidence that smoking cessation can reduce medical costs within five years.