Healthcare financing systems for increasing the use of tobacco dependence treatment.
BACKGROUND
We hypothesized that provision of financial assistance for smokers trying to quit, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts.


OBJECTIVE
The primary objective of this review was to assess the impact of reducing the costs of providing or using smoking cessation treatment by health care financing interventions on abstinence from smoking and utilization of smoking cessation treatment.


METHODS
We searched the Cochrane Tobacco Addiction group specialized register; the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2008; MEDLINE (from January 1966 to August 2008) and EMBASE (from January 1980 to August 2008) to identify trials.


METHODS
We included randomized controlled trials (RCTs) and controlled trials involving financial benefit interventions to smokers or their health care providers or both.


METHODS
Three reviewers independently extracted data and assessed the quality of the included studies. Rate ratios (RR) were calculated for individual studies on an intention-to-treat basis and meta-analysis was performed using a random effects model. We included economic evaluations when a study presented the costs and effects of two or more alternatives.


RESULTS
We found nine trials involving financial interventions directed at smokers and two studies directed at health care providers.There was a statistically significant favourable effect of full financial interventions directed at smokers on continuous abstinence compared to no interventions with a risk ratio (RR) of 4.38 (95% CI 1.94 to 9.87). There was also a significant effect of full financial interventions when compared to no interventions on the number of participants making a quit attempt (RR 1.19; 95% CI 1.07 to 1.32; N = 3). There was a significant effect of financial interventions directed at health care providers in increasing the utilization of behavioural interventions for smoking cessation (RR 1.33; 95% CI 1.01 to 1.77). Comparison of full benefit with partial or no benefit resulted in costs per additional quitter ranging from $260 to $1453.


CONCLUSIONS
Full financial interventions directed at smokers when compared to no financial interventions could increase the proportion quitting, quit attempts and utilization of pharmacotherapy by smokers. Although the absolute differences were small the costs per additional quitter were low. The methodological qualities of the included studies need to be taken into consideration in interpreting the conclusions.
Care and Public Health Research Institute (CAPHRI), Maastricht University, P. Debyeplein 1, P.O. Box 616, Maastricht, Netherlands, 6200 MD.
Ayalu A
AA
Reda
Janneke
J
Kaper
Hurmuz
H
Fikrelter
Johan L
JL
Severens
Constant Paul
CP
van Schayck
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*