Nj.pdf

Potential Costs and Benefits of
Smoking Cessation for New Jersey
Pennsylvania State University, Capital College, School of Pennsylvania State University, College of Medicine, Departments of Surgery and Pennsylvania State University, College of Medicine, Department of Health Acknowledgements
This study was made possible by a grant from Pfizer Inc.
Executive Summary
Background. Cigarette smoking is the single leading cause of preventable disease and
preventable death in the United States (US), leading to more than 400,000 deaths annually. The
CDC and the U.S. Department of Health and Human Services have both issued guidelines on
smoking cessation to help people to quit smoking that include: access to counseling, access to all
FDA-approved over-the-counter and prescription medications; multiple quit attempts; and
reduced or eliminated co-pays. However, access to these aids is limited since many payers do
not cover these treatments. The objective of this study was to determine whether the cost of
making such smoking cessation programs available at the state level could be justified by the
benefits.
Methods. We performed a cost-benefit analysis of access to smoking cessation programs using
a societal perspective using state specific data. Smoking cessation programs based on three
treatment alternatives were studied: nicotine replacement therapy (NRT), bupropion, and
varenicline. Each approach was evaluated with and without individual counseling. Benefits were
estimated as reductions in medical expenditures, premature deaths and increased workplace
productivity. Costs were estimated as direct cost of the smoking cessation programs, the lost tax
revenue to the public sector and the lost revenue to retailers and distributors, since smokers who
quit will no longer purchase cigarettes. Other model parameters included how many smokers
take advantage of the programs and the programs' effectiveness in helping smokers to quit. The
cost-benefit model was parameterized using data from CDC, and various national surveys,
including the Behavioral Risk Factors Surveillance Survey and the Current Population Survey.
Results. Results from our model suggested that in New Jersey the annual direct costs to the
economy attributable to smoking were in excess of $8.3 billion, including workplace
productivity losses of $1.8 billion, premature death losses of approximately $2.9 billion, and
direct medical expenditures of $3.6 billion. While the retail price of a pack of cigarettes in New
Jersey is on average $7.48, the combined medical costs and productivity losses attributable to
each pack of cigarettes sold are approximately $30.29 per pack of cigarettes. The ratio of
benefits to cost varies from $0.91 to $2.65 saved per dollar spent on smoking cessation
programs, depending upon the type of intervention. Nicotine replacement therapies, generic
bupropion and varenicline showed substantial benefits to costs from the societal perspective
across the sensitivity ranges used for treatment effectiveness. Only brand name bupropion did
not have a positive benefits to cost ratio at the low end of the range. Detailed results can be
found in Tables 1-8, which are attached.
Conclusions. For most smoking cessation treatments, the benefits of smoking cessation
programs statewide greatly outweigh the cost to implement them.
Table 1: Baseline data on smokers and smoking in New Jersey. Variable
1 Data from the Behavioral Risk Factor Surveillance System, New Jersey Calculated Variable Data Report, 2005. Retrieved on October 5, 2009 from: http://apps.nccd.cdc.gov/s_broker/htmsql.exe/weat/freq_analysis.hsql?survey_year=2005 2 Data from http://visitnj.org/sites/visitnj.org/files/2008-04-tourism-ecom-impact.pdf, New Jersey 3Data from http://www.tobaccofreekids.org/research/factsheets/pdf/0099.pdf, Campaign for Table 2: Total productivity losses attributable to smoking. Includes productivity losses due to premature death, and workplace productivity losses due to absenteeism and the net loss of productive work time. Component
Per Smoker
Premature Death1
Combined
Workplace Productivity2
Combined
Total Productivity Losses
1. SAMMEC. Adult Smoking-Attributable Mortality, Morbidity, and Economic Costs Calculator. Atlanta, GA: CDC; 2008. 2. Data from Bunn WB, 3rd, Stave GM, Downs KE, Alvir JM, Dirani R. Effect of smoking status on productivity loss. J Occup Environ Med 2006 Oct;48(10):1099-108. 3. Per Bunn et al. total cost per current smoker in the labor force is $4430, with a net effect of lost productivity of $1807. 4. Per Bunn et al. total cost per former smoker in the labor force is $2623, with a net effect of $623. Table 3: Direct expenditures on medical care attributable to smoking and smoking-related events in New Jersey. Total expenditures per pack for both medical care and productivity losses are $30.29 per pack. Cost Component1
Per Pack Per Smoker
Adult Expenditures
Neonatal Expenditures
Total Expenditures
1. SAMMEC. Adult Smoking-Attributable Mortality, Morbidity, and Economic Costs Calculator. Atlanta, GA: CDC; 2008. 2. Other Care includes home health, nonperscription drugs, and nondurable medical products. Table 4: Components of cigarette prices, including taxes, distributor markups, and retailer Component
Final Retail Price
1 Economic Research Service, U.S. Department of Agriculture, Tobacco Briefing Room, "Most Frequently Used Tables," Number 9, http://www.ers.usda.gov/ Briefing/tobacco, downloaded January 23, 2007 (adjusted to reflect Philip Morris price cuts to four of its major brands). 2 Data from http://www.tobaccofreekids.org/research/factsheets/pdf/0099.pdf, Campaign for 3 Data from http://www.rjrt.com/StateMsaPayments.aspx, State MSA Payments. Table 5: Costs for smoking cessation treatments. Costs are for a full course of treatment, which Treatment
Alone Counseling
Source: Treatment costs are at national retail pricing from Drugstore.com (2009). Prices were adjusted to 2009 dollars. Table 6: Marginal treatment effectiveness, including baseline values and ranges used in Marginal Treatment
Treatment Option
Effectiveness
1. Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2004(3):CD000146. 2. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2007(1):CD000031. 3. Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2007(1):CD006103. Table 7: Results of cost-benefit analysis at baseline marginal effectiveness No Counseling
Costs/Benefits
Benefit/Cost Ratio
Counseling
Costs/Benefits
Benefit/Cost Ratio
Table 8: Sensitivity analysis of cost-benefit analysis at low values of marginal effectiveness No Counseling
Costs/Benefits
Benefit/Cost Ratio
Counseling
Costs/Benefits
Benefit/Cost Ratio
Table 9: Sensitivity analysis of cost-benefit analysis at high values of marginal effectiveness No Counseling
Costs/Benefits
Benefit/Cost Ratio
Counseling
Costs/Benefits
Benefit/Cost Ratio

Source: http://www.njgasp.org/ALA-9-21-2010-pennstate-NJ.pdf