Healthcare financing systems for increasing the use of tobacco dependence treatment.
BACKGROUND
Smoking cessation treatment increases the number of successful quitters compared with unaided attempts to quit. However, only a small proportion of people who smoke take up treatment. One way to increase the use of smoking cessation treatment might be to give financial support through healthcare systems.


OBJECTIVE
The primary objective of this review was to assess the effect of using healthcare financing interventions to reduce the costs of providing or using smoking cessation treatment on abstinence from smoking.


METHODS
Eligible studies were identified by a search of the Cochrane Tobacco Addiction group specialized register, the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2003, MEDLINE (from January 1966 to August 2003) and EMBASE (from January 1980 to October 2003), screening references of relevant reviews and studies, and contacting experts in the field.


METHODS
We included randomized controlled trials (RCTs), controlled trials (CTs) and interrupted time series (ITS) in which the study population consisted of smokers or healthcare providers or both.


METHODS
Two reviewers independently extracted data and assessed the quality of the included studies. We calculated odds ratios (ORs) and risk differences (RDs) for the individual studies and performed meta-analysis using a random-effects model. We included economic evaluations when a study presented the costs and effects of two or more alternatives.


RESULTS
Four RCTs and two CTs were directed at smokers. Five studies compared the effect of a full benefit with no benefit of which four reported the prolonged self-reported abstinence rate and showed an increase of 2% (95% confidence interval [CI] 0.00 to 0.05). The pooled OR for achieving abstinence for a period of six months was 1.48 (95% 1.17 to 1.88). Two studies directed at smokers compared a full benefit with a partial benefit and showed that the odds of being abstinent were 2.49 times higher with a full benefit (95% CI 1.59 to 3.90). The pooled RD showed a non-significant increase (RD 0.05; 95% CI -0.07 to 0.16). Only one study compared a partial benefit with no benefit and only one study was directed at healthcare providers. When a full benefit was compared with a partial or no benefit, the costs per quitter varied between $260 and $2330.


CONCLUSIONS
There is some evidence that healthcare financing systems directed at smokers which offer a full financial benefit can increase the self-reported prolonged abstinence rates at relatively low costs when compared with a partial or no benefit. Since there were some limitations to the methodological quality of the studies the results should be interpreted with caution. More studies are needed on the effects of healthcare financing systems directed at healthcare providers.
Kaper
J
J
Care and Public Health Research Institute (CAPHRI), Maastricht University, P. Debyeplein 1, P.O Box 616, Maastricht, Netherlands, 6200 MD. janneke.kaper@hag.unimaas.nl
Wagena
E J
EJ
Severens
J L
JL
Van Schayck
C P
CP
D003362:Cost-Benefit Analysis; D005380:Financing, Government; D006801:Humans; D019458:Insurance Coverage; D016032:Randomized Controlled Trials as Topic; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000191:economics; D020340:Tobacco Use Cessation / Q000191:economics*; D014029:Tobacco Use Disorder / Q000191:economics / Q000628:therapy*