[Comparison of insurance coverage of tobacco cessation pharmacotherapies in five countries from the Organisation for Economic Co-operation and Development].
BACKGROUND
Reports in the literature demonstrate effectiveness and cost-effectiveness of tobacco treatments including drug and behavioral therapies. The health insurance coverage of smoking cessation treatments could lower financial barriers which limit the access to these services. The purpose of this paper was to compare health insurance coverage for pharmacotherapies for smoking cessation in five countries from the Organisation for Economic Co-operation and Development.


METHODS
A literature review was performed using Medline, official websites and Google. A grid was used to analyse articles and reports in order to identify: the public or private coverage of smoking cessation pharmacotherapies; the population groups who were covered; the extent and content of the insurance coverage as well as the practical ways to obtain it and the training and certification of the health staff to prescribe these treatments.


RESULTS
Australia, Quebec, the United States, New Zealand and the United Kingdom provide financial coverage for some of the drugs prescribed to stop smoking. The financial coverage depends on the organization of the health care system: universal coverage in Australia, Quebec, New Zealand, and the United Kingdom and private coverage in the United States except for the Medicaid public program. In the United States as well as in the United Kingdom the first population group to benefit from financial coverage of smoking cessation therapy were socially precarious persons. Prescription schemes are recommended in the present programs and persons who receive the treatment are generally requested to attend follow-up visits. All countries studied encourage training of health professionals in tobacco cessation, but except for Australia and New Zealand there is no mandatory registration of physicians who prescribe smoking cessation drugs.


CONCLUSIONS
The financial coverage of smoking cessation pharmacotherapies is often the result of a political decision. Taking into consideration the situation of developed countries, France should first consider the financial coverage of smoking cessation pharmacotherapies for socially precarious persons and populations with tobacco-related diseases. In addition, a population-based study should be conducted in France to measure the efficacy of financial coverage on smoking cessation.
Le Faou
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AL
Département de Santé publique, Faculté de Médecine Paris 5, Université René-Descartes, 15, rue de l'Ecole de Médecine, 75270 Paris Cedex 06. anne-laurence.le-faou@spim.jussieu.fr
Scemama
O
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D001315:Australia; D018765:Dopamine Uptake Inhibitors / Q000191:economics; D005500:Follow-Up Studies; D006282:Health Personnel / Q000193:education; D006801:Humans; D019458:Insurance Coverage / Q000145:classification / Q000191:economics* / Q000458:organization & administration; D007348:Insurance, Health / Q000145:classification / Q000191:economics*; D009520:New Zealand; D009538:Nicotine / Q000037:antagonists & inhibitors; D011792:Quebec; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D000074606:Smoking Prevention; D006113:United Kingdom; D014481:United States
D018765:Dopamine Uptake Inhibitors; D009538:Nicotine