title: Healthcare costs around the time of smoking cessation.
abstract: BACKGROUND
  The Affordable Care Act mandates that new insurance plans cover smoking-cessation therapy without cost-sharing. Previous cost difference estimates, which show a spike around the time of cessation, suggest premiums might rise as a result of covering these services.
  
  
  OBJECTIVE
  The goal of the study was to test (1) whether individuals in an RCT of pharmacotherapy and counseling for smoking cessation differed in their healthcare costs around the cessation period, and (2) whether the healthcare costs of those in the trial who successfully quit were different from a matched sample of smokers in the community.
  
  
  METHODS
  Generalized linear regression models were used to analyze healthcare cost data on individuals enrolled in a comparative effectiveness trial of cessation therapies between October 2005 and May 2007 (1346 total participants; 1338 with requisite data for further analysis). Cost differences for the period preceding and subsequent to the cessation attempt were assessed by trial participants' 12-month sustained quit status. Healthcare cost differences between sustained quitters and a sample of community-dwelling smokers, matched to these quitters on the basis of health services use around the time trial participant enrolled and by demographics, were also examined. Data were analyzed in 2011.
  
  
  RESULTS
  All three groups had a spike in cost associated with the index clinic visit. Regression results revealed little difference in healthcare costs by quit status for trial participants until the sixth quarter post-quit. By that quarter, continuous sustained quitters cost $541 (p<0.001) less than continuing smokers. Continuous sustained quitters cost less than their matched community- dwelling smokers in almost every quarter observed. The cost difference ranged from $270 (p=0.01) during the quarter of quit, to $490 (p<0.01) in the 6th quarter after quitting.
  
  
  CONCLUSIONS
  The inclusion of smoking-cessation therapy does not appear to raise short-term healthcare costs. By the sixth quarter post-quit, sustained quitters were less costly than trial participants who continued smoking.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. jason.hockenberry@emory.edu
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hockenberry
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Curry
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fishman
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Baker
authors.forename: David L
authors.initials: DL
authors.lastname: Fraser
authors.forename: Ron A
authors.initials: RA
authors.lastname: Cisler
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Jackson
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fiore
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D019538:Health Care Surveys; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D016540:Smoking Cessation / Q000191:economics*; D014481:United States; D014922:Wisconsin; D055815:Young Adult