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A Longitudinal Study of Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Hospitalizations for Cardiovascular Disease


Background:
Insurance coverage of tobacco cessation medications increases their use and reduces smoking prevalence in a population. However, uncertainty about the impact of this coverage on health care utilization and costs is a barrier to the broader adoption of this policy, especially by publicly funded state Medicaid insurance programs. Whether a publicly funded tobacco cessation benefit leads to decreased medical claims for tobacco-related diseases has not been studied. We examined the experience of Massachusetts, whose Medicaid program adopted comprehensive coverage of tobacco cessation medications in July 2006. Over 75,000 Medicaid subscribers used the benefit in the first 2.5 years. On the basis of earlier secondary survey work, it was estimated that smoking prevalence declined among subscribers by 10% during this period.

Methods and Findings:
Using claims data, we compared the probability of hospitalization prior to use of the tobacco cessation pharmacotherapy benefit with the probability of hospitalization after benefit use among Massachusetts Medicaid beneficiaries, adjusting for demographics, comorbidities, seasonality, influenza cases, and the implementation of the statewide smoke-free air law using generalized estimating equations. Statistically significant annualized declines of 46% (95% confidence interval 2%–70%) and 49% (95% confidence interval 6%–72%) were observed in hospital admissions for acute myocardial infarction and other acute coronary heart disease diagnoses, respectively. There were no significant decreases in hospitalizations rates for respiratory diagnoses or seven other diagnostic groups evaluated.

Conclusions:
Among Massachusetts Medicaid subscribers, use of a comprehensive tobacco cessation pharmacotherapy benefit was associated with a significant decrease in claims for hospitalizations for acute myocardial infarction and acute coronary heart disease, but no significant change in hospital claims for other diagnoses. For low-income smokers, removing the barriers to the use of smoking cessation pharmacotherapy has the potential to decrease short-term utilization of hospital services.

: Please see later in the article for the Editors' Summary


Vyšlo v časopise: A Longitudinal Study of Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Hospitalizations for Cardiovascular Disease. PLoS Med 7(12): e32767. doi:10.1371/journal.pmed.1000375
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000375

Souhrn

Background:
Insurance coverage of tobacco cessation medications increases their use and reduces smoking prevalence in a population. However, uncertainty about the impact of this coverage on health care utilization and costs is a barrier to the broader adoption of this policy, especially by publicly funded state Medicaid insurance programs. Whether a publicly funded tobacco cessation benefit leads to decreased medical claims for tobacco-related diseases has not been studied. We examined the experience of Massachusetts, whose Medicaid program adopted comprehensive coverage of tobacco cessation medications in July 2006. Over 75,000 Medicaid subscribers used the benefit in the first 2.5 years. On the basis of earlier secondary survey work, it was estimated that smoking prevalence declined among subscribers by 10% during this period.

Methods and Findings:
Using claims data, we compared the probability of hospitalization prior to use of the tobacco cessation pharmacotherapy benefit with the probability of hospitalization after benefit use among Massachusetts Medicaid beneficiaries, adjusting for demographics, comorbidities, seasonality, influenza cases, and the implementation of the statewide smoke-free air law using generalized estimating equations. Statistically significant annualized declines of 46% (95% confidence interval 2%–70%) and 49% (95% confidence interval 6%–72%) were observed in hospital admissions for acute myocardial infarction and other acute coronary heart disease diagnoses, respectively. There were no significant decreases in hospitalizations rates for respiratory diagnoses or seven other diagnostic groups evaluated.

Conclusions:
Among Massachusetts Medicaid subscribers, use of a comprehensive tobacco cessation pharmacotherapy benefit was associated with a significant decrease in claims for hospitalizations for acute myocardial infarction and acute coronary heart disease, but no significant change in hospital claims for other diagnoses. For low-income smokers, removing the barriers to the use of smoking cessation pharmacotherapy has the potential to decrease short-term utilization of hospital services.

: Please see later in the article for the Editors' Summary


Zdroje

1. US Centers for Disease Control and Prevention 2008 Smoking-attributable mortality, years of potential life lost, and productivity losses---United States, 2000-2004. MMWR 57 1226 1228

2. AbramsDA

GrahamAL

LevyDT

MabryPL

OrleansCT

2010 Boosting population quits through evidence-based cessation treatment and policy. Am J Prev Med 2010 38 S351 S363

3. FioreMC

Jae'nCR

BakerTB

BaileyWC

BenowitzNL

CurrySJ

2008 Treating tobacco use and dependence: 2008 update. Clinical practice guideline Rockville (Maryland) US Department of Health and Human Services Public Health Service; May 2008

4. CurrySJ

GrothausLC

McAfeeT

PabiniakC

1998 Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. N Engl J Med 339 673 679

5. LandT

WarnerD

PaskowskyM

CammaertsA

WetherellL

2010 Medicaid coverage for tobacco dependence treatments in Massachusetts and associated decreases in smoking prevalence. PLoS ONE 5 e9770 doi:10.1371/journal.pone.0009770

6. McMenaminSB

HalpinHA

BellowsNM

HustenCG

Center for Health and Public Policy Studies, University of California, Berkeley 2009 State Medicaid coverage for tobacco-dependence treatments --- United States, 2007. MMWR 58 1199 1204

7. WagnerEH

CurrySJ

GrothausL

SaundersKW

McBrideCM

1995 The impact of smoking and quitting on health care use. Arch Intern Med 155 1789 1795

8. FishmanPA

ThompsonEE

MerikleE

Curry, SJ 2006 Changes in health care costs before and after smoking cessation. Nicotine Tob Res 8 393 401

9. MartinsonBC

O'ConnorPJ

PronkNP

Rolnick SJ. 2003 Smoking cessation attempts in relation to prior health care charges: the effect of antecedent smoking-related symptoms? Am J Health Promot 18 125 132

10. MusichS

FaruzziSD

LuC

McDonaldT

HirschlandD

2003 Pattern of medical charges after quitting smoking among those with and without arthritis, allergies, or back pain. Am J Health Promot 18 133 142

11. The Kaiser Commission on Medicaid and the Uninsured 2010 Medicaid A primer: key information on our nations' health coverage program for low-income people. Menlo Park (California) The Kaiser Commission on Medicaid and the Uninsured 27

12. Centers for Disease Control and Prevention 2006 Sustaining state programs for tobacco control: data highlights 2006. Available: http://www.cdc.gov/tobacco/data_statistics/state_data/data_highlights/2006/00_pdfs/DataHighlights06rev.pdf. Accessed 19 February 2010

13. HCUP Clinical Classifications Software (CCS) for ICD-9-CM. Healthcare Cost and Utilization Project (HCUP). 2000-2003. Rockville (Maryland) Agency for Healthcare Research and Quality Available: www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed 11 July 2005

14. Available: http://www.jointcommission.org/NR/rdonlyres/48DFC95A-9C05-4A44-AB05-1769D5253014/0/AComprehensiveReviewofDevelopmentforCoreMeasures.pdf. Accessed 23 August 2010

15. KronickR

GilmerT

DreyfusT

LeeL

2000 Improving health-based payment for Medicaid beneficiaries: CDPS. Hlth Care Fin Rev 21 29 64

16. MadjidM

MillerCC

ZarubaevVV

2007 Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34,892 subjects. Eur Heart J 28 1205 1210

17. StolwijkAM

StraatmanH

ZielhuisGA

1999 Studying seasonality by using sine and cosine functions in regression analysis. J Epidemiol Community Health 53 235 238

18. CritchleyJA

CapewellS

2003 Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA 290 86 97

19. DresslerCM

ME, StraifK

BaanR

SecretanB

Leon 2006 Reversal of risk upon quitting smoking. Lancet 368 348 349

20. JusterHR

LoomisBR

HinmanTM

FarrellyMC

HylandA

2007 Declines in hospital admissions for acute myocardial infarction in New York State after implementation of a comprehensive smoking ban. Am J Public Health 97 2035 2039

21. DoveM

DockeryDW

MittlemanMA

SchwartzJ

SullivanEM

2010 The impact of Massachusetts' smoke-free workplace laws on acute myocardial infarction deaths. Am J Public Health 100 2206 2212

22. HermanPM

WalshNE

2010 Hospital admissions for acute myocardial infarction, angina, stroke, and asthma after implementation of Arizona's comprehensive statewide smoking ban. Am J Public Health In press

23. Institute of Medicine 2009 Secondhand smoke exposure and cardiovascular effects: making sense of the evidence. Washington (D.C.) National Academy of Sciences, Institute of Medicine

24. EvansGW

KantrowitzE

2002 Socioeconomic status and health: the potential role of environmental risk exposure. Annu Rev Public Health 23 303 331

25. FaberDR

KriegEJ

2002 Unequal exposure to ecological hazards: environmental injustices in the Commonwealth of Massachusetts. Environ Health Perspect 110 277 288

26. ChangVW

LauderdaleDS

2005 Income disparities in body mass index and obesity in the United States, 1971-2002. Arch Intern Med 165 2122 2128

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Interné lekárstvo

Článok vyšiel v časopise

PLOS Medicine


2010 Číslo 12
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Autori: MUDr. Tomáš Ürge, PhD.

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