title: National trends in the provision of smoking cessation aids within the Veterans Health Administration.
abstract: OBJECTIVE
  To evaluate the effectiveness of the Veterans Health Administration (VHA) in providing treatment for tobacco dependence, accomplished by estimating national trends in the number and percent of smokers receiving smoking cessation aids (SCAs) within the VHA, trends in SCA utilization and expenditures, and the impact of lifting restrictions on patient access to SCAs.
  
  
  METHODS
  All patients receiving an outpatient SCA prescription were identified within the Veterans Affairs (VA) Pharmacy Benefits Management database over a 4-year period- October 1, 1998 (n = 61 968) to September 30, 2002 (n = 76 641). Smoking prevalence was based on data from the VA's 1999 Large Health Survey of Enrollees. A subsample of sites was classified as having restricted access to SCAs if patients were required to attend smoking cessation classes. Changes in annual SCA utilization rates and expenditures by SCA type and restriction status were measured to assess changes in treatment of tobacco dependence.
  
  
  RESULTS
  Approximately 7% of smokers received SCA prescriptions, and SCAs accounted for less than 1% of the VHA's annual outpatient pharmacy budget in any given year. Following downward trends in the cost of 30-day SCA prescriptions, annual SCA expenditures per patient decreased over time. Expenditures were lower for restricted than unrestricted sites. More than two thirds of smokers who were prescribed medications received the nicotine patch, a quarter received bupropion sustained-release, and fewer than 10% received nicotine gum.
  
  
  CONCLUSIONS
  Measures of SCA utilization and cost are low, stable, and less than the recommended rates in national smoking cessation guidelines, suggesting that this population of smokers is undertreated. Removing SCA restrictions is not prohibitively expensive and improves access to cost-effective care.
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, One Veterans Drive 1110, Minneapolis, MN 55417, USA. yjonk@umn.edu
authors.forename: Yvonne C
authors.initials: YC
authors.lastname: Jonk
authors.forename: Scott E
authors.initials: SE
authors.lastname: Sherman
authors.forename: Steven S
authors.initials: SS
authors.lastname: Fu
authors.forename: Kim W
authors.initials: KW
authors.lastname: Hamlett-Berry
authors.forename: Mark C
authors.initials: MC
authors.lastname: Geraci
authors.forename: Anne M
authors.initials: AM
authors.lastname: Joseph
mesh_terms: D000328:Adult; D000368:Aged; D016642:Bupropion / Q000008:administration & dosage* / Q000191:economics / Q000600:supply & distribution; D002638:Chewing Gum; D019992:Databases as Topic; D017723:Drug Utilization Review; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage* / Q000191:economics / Q000600:supply & distribution; D010607:Pharmacy Service, Hospital / Q000191:economics; D012907:Smoking / Q000188:drug therapy* / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
chemical_list: D002638:Chewing Gum; D016642:Bupropion; D009538:Nicotine