The Effectiveness of Covering Smoking Cessation Services for Medicare Beneficiaries

OBJECTIVE: To examine whether reimbursement for Provider Counseling, Pharmacotherapies, and a telephone Quitline increase smoking cessation relative to Usual Care. STUDY DESIGN: Randomized comparison trial testing the effectiveness of four smoking cessation benefits. SETTING: Seven states that best represented the national population in terms of the proportion of those >65 years of age and smoking rate. PARTICIPANTS: There were 7,354 seniors voluntarily enrolled in the Medicare Stop Smoking Program and they were followed-up for 12 months. Intervention(s). (1) Usual Care, (2) reimbursement for Provider Counseling, (3) reimbursement for Provider Counseling with Pharmacotherapy, and (4) telephone counseling Quitline with nicotine patch. MAIN OUTCOME MEASURE: Seven-day self-reported cessation at 6- and 12-month follow-ups. PRINCIPAL FINDINGS: Unadjusted quit rates assuming missing data = smoking were 10.2 percent (9.0-11.5), 14.1 percent (11.7-16.5), 15.8 percent (14.4-17.2), and 19.3 percent (17.4-21.2) at 12 months for the Usual Care, Provider Counseling, Provider Counseling + Pharmacotherapy, and Quitline arms, respectively. Results were robust to sociodemographics, smoking history, motivation, health status, and survey nonresponse. The additional cost per quitter (relative to Usual Care) ranged from several hundred dollars to $6,450. CONCLUSIONS: A telephone Quitline in conjunction with low-cost Pharmacotherapy was the most effective means of reducing smoking in the elderly.