Christopher Hollenbeak, Ph.D., Pennsylvania State University, College of Medicine, Departments of Surgery and Public Health Sciences, in Hershey and Jill S. Rumberger, Ph.D., Pennsylvania State University, Capital College, School of Public Affairs in Harrisburg, are the authors of the 2008 report, Potential Costs and Benefits of Statewide Smoking Cessation in Pennsylvania. Their research formed the basis of a new nationwide study released on Tuesday, Smoking Cessation: The Economic Benefits. Dr. Hollenbeak and Deb Brown, acting CEO of the American Lung Association of the Mid-Atlantic, are our guests on Thursday night. The study was funded by Pfizer, marketer of one of the cessation-related drugs, varenicline, cited favorably in the study.
READ THE STUDY: Potential Costs and Benefits of Smoking Cessation for Pennsylvania
Smoking takes a terrible toll on human health. Each year, 393,000 people in America die prematurely from tobacco use. In fact, cigarette smoking is the single leading cause of preventable disease and preventable death in the U.S. Smoking contributes fundamentally to many other diseases, like lung cancer, cardiovascular disease, and chronic obstructive pulmonary disease (COPD).
Pennsylvania has taken some steps to ameliorate the effects of smoking and to encourage people to quit. Lawmakers enacted a statewide ban on smoking in restaurants and most workplaces. And whenever the budgeteering gets especially tough in Harrisburg, legislators and the governor raise the taxes on a pack of smokes to generate more revenue. The state earmarks a portion of its massive tobacco lawsuit settlement funds each year to pay for state and local cessation programs. But, in another sign of the troubled economic times, the governor has dipped into the tobacco settlement money and diverted funds from cessation programs to other general fund obligations. It amounted to a 45% cut for FY 2010. One can only surmise that more of these diversions will occur as the state budget remains tight for the next few years.
So what's the cure? To proponents of cessation, it's more state funding. They note that Pennsylvania earned an "F" in 2009 from the ALA for its efforts to support and fund tobacco-control programs. And they want policymakers to require insurers to cover comprehensive cessation treatment which would entail a combination of counseling and FDA-approved cessation aids. But that would also entail an increase in health-insurance premiums, something consumers and policymakers want to avoid. Experts admit that only 5% of smokers will kick the habit but they take heart from Massachusetts' experience. The state added a comprehensive cessation benefit to its Medicaid plan and found that smoking rates among the poor plunged 26 percent in the first two years of its adoption.
Recommended guidelines from The Centers for Disease Control and the U.S. Department of Health and Human Services say quality cessation programs should include access to counseling, FDA-approved over-the-counter and prescription medications, reduced or no co-pays, as well as the recognition that it often takes several attempts before a person successfully kicks the habit. So, do the costs of smoking cessation programs in Pennsylvania justify providing these kinds of benefits? According to this study, the answer is overwhelmingly, yes. Here's what the researchers found:
-- In Pennsylvania, the annual direct costs to the economy attributable to smoking were in excess of $16 billion – this includes workplace productivity losses of $9.6 billion; premature death losses of $5.5 billion; and direct medical expenditures of $6.9 billion.
-- The retail price of a pack of cigarettes in Pennsylvania is on average $4.72. The combined medical costs and productivity losses in Pennsylvania attributable to each pack of cigarettes sold are approximately $23.78 per pack of cigarettes.
--The ratio of benefits to cost varies from $1.28 to $2.76 saved per dollar spent on smoking cessation programs, depending upon the type of intervention.
-- The average benefits across all potential smoking cessation programs are nearly 60% greater than the average costs.
"There are two types of benefits to society from smoking cessation. First, smokers who quit successfully will have fewer medical expenses. And, second, smokers who quit successfully will have higher workplace productivity due to reduced absenteeism and increased productivity during working hours," the researchers concluded.
They also acknowledged the potential for large and sustained revenue losses. First, state tax coffers suffer when people stop buying cigarettes. And, retailers and other businesses that sell tobacco products lose revenue, too, not to mention Pennsylvania's tobacco growers who will find less demand for their products. The potential economic loss to growers was one reason lawmakers failed to approve a tax on smokeless and other tobacco products to help close this year's budget deficit.
The researchers focused on three treatment options for smoking cessation: nicotine replacement therapy (NRT), bupropion (marketed by GlaxoSmithKline) , and varenicline (marketed by Pfizer). They studied each approach with and without individual counseling. The analysis found that "with the right combination of smoking cessation programs, the Commonwealth of Pennsylvania could see great results from both a health and economic perspective."
One final thought to ponder, or to put in your pipe and smoke it: Most standard health plans will cover a lung transplant, but won't help pay for smoking-cessation counseling or treatment.
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