Employer-sponsored insurance coverage of smoking cessation treatments

To investigate the costs and benefits of covering smoking cessation interventions from insurers' and employers' perspectives.

A Monte Carlo model was used to simulate smoking status and health expenditures in a hypothetical population of employees over a period of 20 years.

Population characteristics were drawn from the 1997-2002 National Health Interview surveys. Multivariate regressions using a number of publicly available datasets from 1996-2002 generated transition probabilities for the simulation. The costs and benefits of scenarios where smoking cessation treatments were covered were compared with a scenario where none were covered. Sensitivity to parameter estimates was evaluated.

By the final simulation year, insurers had benefit-cost ratios of 0.56 to 1.67 with per member per month costs of -$0.22 to $0.43. The earliest year at which savings were achieved for insurers was year 8. Employers saw benefit-cost ratios of 1.88 to 5.58 by the final simulation year with per member per month costs of -$1.23 to -$0.15. Employers achieved savings as early as year 3 and as late as year 8. Models were sensitive to the rate at which population members were assumed to exit the insurer or employer.

Both insurers and employers may add smoking cessation benefits at minimal burden to their members and with potential savings, particularly where the population of interest is relatively stable.