title: Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization.
abstract: BACKGROUND
  Lack of information about the effect of insurance coverage on the demand for and use of smoking-cessation services has prevented widescale adoption of coverage for such services.
  
  
  METHODS
  In a longitudinal, natural experiment, we compared the use and cost effectiveness of three forms of coverage with those of a standard form of coverage for smoking-cessation services that included a behavioral program and nicotine-replacement therapy. The study involved seven employers and a total of 90,005 adult enrollees. The standard plan offered 50 percent coverage of the behavioral program and full coverage of nicotine-replacement therapy. The other plans offered 50 percent coverage of both the behavioral program and nicotine-replacement therapy (reduced coverage), full coverage of the behavioral program and 50 percent coverage of nicotine-replacement therapy (flipped coverage), or full coverage of both the behavioral program and nicotine-replacement therapy.
  
  
  RESULTS
  Estimated annual rates of use of smoking-cessation services ranged from 2.4 percent (among smokers with reduced coverage) to 10 percent (among those with full coverage). Smoking-cessation rates ranged from 28 percent (among users with full coverage) to 38 percent (among those with standard coverage). The estimated percentage of all smokers who would quit smoking per year as a result of using the services ranged from 0.7 percent (with reduced coverage) to 2.8 percent (with full coverage). The average cost to the health plan per user who quit smoking ranged from $797 (with standard coverage) to $1,171 (with full coverage). The annual cost per smoker ranged from $6 (with reduced coverage) to $33 (with full coverage). The annual cost per enrollee ranged from $0.89 (with reduced coverage) to $4.92 (with full coverage).
  
  
  CONCLUSIONS
  Use of smoking-cessation services varies according to the extent of coverage, with the highest rates of use among smokers with full coverage. Although the rate of smoking cessation among the benefit users with full coverage was lower than the rates among users with plans requiring copayments, the effect on the overall prevalence of smoking was greater with full coverage than with the cost-sharing plans.
authors.affiliation: Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Curry
authors.forename: L C
authors.initials: LC
authors.lastname: Grothaus
authors.forename: T
authors.initials: T
authors.lastname: McAfee
authors.forename: C
authors.initials: C
authors.lastname: Pabiniak
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics* / Q000706:statistics & numerical data; D014861:Washington