Older Smokers' Quit Rate Rises with Patches and Phones

By Charles Bankhead
SANTA MONICA, 23 aug 2008-- Older smokers doubled their quit rate when given nicotine patches and access to telephone counseling, showed a Medicare demonstration program.
The one-year quit rate was almost 20% compared with 10% for smokers who received a brochure about smoking cessation (usual care), Geoffrey Joyce, Ph.D., of the RAND Corp. here, and colleagues, reported online in Health Services Research.
Physician counseling and the combination of counseling and medical therapy also led to higher quit rates compared with usual care.
"The results of this study suggest that a fully integrated [Medicare] benefit structured around low-cost pharmacotherapy in conjunction with available free quitline services would substantially reduce the prevalence of smoking and smoking-related illness among elderly beneficiaries motivated to quit, at a relatively modest cost," the authors concluded.
Smoking-cessation efforts have primarily targeted the young, before they become habitual smokers. However, increasing evidence suggests that quitting smoking after decades of exposure can substantially reduce smoking-related illness, the authors noted.
"A person smoking twenty or more cigarettes per day and who quit at age 65 could expect to increase their life expectancy by two to three years, in addition to any improvements in quality of life," they said.
Most private and public health plans do not fully cover smoking-cessation services, in part because of a lack of evidence that insurance coverage increases long-term abstinence, particularly among older adults who often have smoked for decades.
Dr. Joyce and coauthors reported findings from the Medicare Stop Smoking Program, the first large-scale demonstration to test the effectiveness and cost-effectiveness of Medicare coverage for smoking cessation. The study involved 7,354 persons ages 65 and older in seven states (Alabama, Florida, Ohio, Oklahoma, Missouri, Nebraska, and Wyoming).
Medicare beneficiaries in the seven states were recruited into four intervention groups:
A brochure about smoking cessation (usual care).
Reimbursement for four counseling sessions with a physician.
Reimbursement for counseling and smoking-cessation drug therapy (nicotine patches or bupropion [Zyban]).
Nicotine patches plus a telephone hotline.
Any Medicare-eligible primary care clinicians in the study areas could participate in the study and be eligible for reimbursement.
The primary outcome was self-reported smoking cessation at six and 12-months.
Because of the study's nonrandomized design and various recruitment obstacles, enrollment in the four interventions was unbalanced: 2,230 participants were in usual care, 829 in provider counseling, 2,605 in counseling plus optional drug therapy, and 1,690 in nicotine patches plus the telephone hotline.
The six-month quit rates were 9.9% with usual care, 11.9% with provider counseling, 15.8% with counseling plus drug therapy (P=0.05 versus usual care), and 21.2% with nicotine patches plus telephone counseling (P=0.05 versus usual care). At 12 months, the quit rate with usual care (10.2%) was significantly lower compared with each of the other interventions (P=0.05):
14.1% with provider counseling
15.8% with counseling plus drug therapy
19.3% with nicotine patches plus telephone counseling and support
"Rates of confirmed smoking cessation in the Medicare Stop Smoking Program compared favorably with quit rates in the general population and were higher than expected for older adults," the authors said.
Compared with usual care, the additional cost to Medicare for each quitter ranged from $463 with physician counseling alone to $6,450 with nicotine patches and the telephone hotline.
The authors noted several limitations of the study: imbalances in patient enrollment, lack of information about the number and quality of counseling sessions that participants in those groups received, and reliance on self-reported information and cessation rates.
The study was funded by a contract with the Centers for Medicare & Medicaid Services.
The authors reported no conflicts of interest.
Primary source: Health Services ResearchSource reference:Joyce GF et al. "The effectiveness of covering smoking cessation services for Medicare beneficiaries" Health Serv Res 2008; epub.