The association between smoking cessation outpatient visits and total medical costs: a retrospective, observational analysis of Japanese employee-based public health insurance data

Abstract

Aims: The short-term effects of smoking cessation (SC) on overall healthcare costs are unclear. This study aimed to compare the short-term medical costs between patients with SC outpatient visits (SCOVs) and those without SCOVs, consisting of SCOV itself and overall medical costs.

Materials and methods: This study is a retrospective, observational study using a Japanese employee-based health insurance claims database (January 1, 2005–December 31, 2013). It analyzed individuals who were registered as smokers based on their medical checkup details. It compared the per-patient-per-year (PPPY) medical costs for male smokers who made ≥1 claim for SCOVs with those who made no claims. We also assessed whether the number of SCOVs by male and female smokers impacted medical costs. The Index Year was the year after the first SCOV claim and that after the first registration as a smoker (non-SCOV group). Medical costs were calculated using regression analysis and adjusted for baseline costs.

Results: In Index Year −1, PPPY medical costs for male smokers were ∼USD 323.01 (JPY 36,500, as of November 2017) higher in the SCOV (n = 5,608) vs the non-SCOV (n = 81,721) group; however, by Year 6 the costs were similar. From Year 4–6, PPPY medical costs for SCOVs were lower than those in the adjusted non-SCOV group. For 2,576 male and female smokers in the SCOV group, the average rates of increasing medical costs before and after the SCOV for 1, 2, 3, 4, and 5 SCOVs made were 58%, 44%, 50%, 41%, and 34%, respectively.

Limitations: The database includes limited data on individuals >65 years. Only SCOVs based on claims data and not on other outcomes were assessed.

Conclusions: Medical costs declined in the short-term following the first SCOV. Attendance at a greater number of SCOVs was associated with a lower increase ratio of medical costs.

Keywords:

• Smoking cessation
• health insurance
• outpatient visits
• medical costs
• claims data

Transparency

Declaration of funding

This study was funded by Pfizer.

Declaration of financial interests/other relationships

KS and RY are employees of Pfizer. KI is an employee of Milliman, Inc., who was hired as a consultant for the development of this manuscript. AI reports grants and personal fees from Pfizer Japan during the conduct of the study; grants from Gilead Sciences, AbbVie, Abbott Japan, Beckton Dickinson and Company, Eli Lilly Japan, CSL Behring Japan, Fuji Film, Takeda Pharmaceutical, Milliman, Bristol-Myers Squibb, Intuitive Surgical, Boston Scientific Japan, Sanofi Japan, and Terumo Corporation outside of the submitted work; and personal fees from Chugai Pharmaceuticals, Astellas Pharma, and Creativ-Ceuticals outside of the submitted work. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Editorial support was provided by Michelle Jenvey, PhD; Katy Beck, PhD; and Anne Jakobsen, MSc, at Engage Scientific Solutions. The editorial support was funded by Pfizer.

Previous presentations

Parts of this study were presented at the ISPOR 18th Annual European Congress.