Health care costs among smokers, former smokers, and never smokers in an HMO.
OBJECTIVE
We estimate long-term health care costs of former smokers compared with continuing and never smokers using a retrospective cohort study of HMO enrollees. Previous research on health care costs associated with former smokers has suggested that quitters may incur greater health care costs than continuing smokers, therefore, getting people to quit creates more expensive health care consumers. We studied the trend in cost for former smokers over seven years after they quit to assess how the cessation experience impacts total health care cost.


METHODS
Group Health Cooperative (GHC), a nonprofit mixed model health maintenance organization in western Washington state.


METHODS
Retrospective cohort study using automated and primary data collected through telephone interviews.


RESULTS
We find that former smokers' costs are significantly greater (p<.05) in the year immediately following cessation relative to continuing smokers, but former smokers' costs fall in year two. This decrease maintains throughout the six-year follow-up period. Although former smokers cost more than continuing smokers in the year after cessation, this increase appears to be transient. Long-term costs for former smokers are not statistically different from those of continuing smokers and cumulative health care expenses are lower by the seventh year postquit. Our evidence suggests that smoking cessation does not increase long-term heath care costs.


CONCLUSIONS
Health care costs among former smokers increase relative to continuing smokers in the year after cessation but fall to a level that is statistically indistinguishable in the second year postquit. Any net increase in costs among former smokers relative to continuing smokers appears compensated for within two years post-quit and is maintained for at least six years after cessation.
Fishman
Paul A
PA
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101, USA.
Khan
Zeba M
ZM
Thompson
Ella E
EE
Curry
Susan J
SJ
D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data* / Q000639:trends; D006279:Health Maintenance Organizations / Q000191:economics* / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012907:Smoking / Q000191:economics* / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics*; D014861:Washington / Q000453:epidemiology