Economic Model of Sustained-Release Bupropion Hydrochloride
Economic Model of Sustained-Release Bupropion Hydrochloride
The development and application of an economic model designed to assess the specific costs and benefits of health plan coverage of smoking-cessation programs involving sustained-release bupropion hydrochloride are described.
A cohort of 100,000 employees or health plan members and 60,000 adult dependents was followed from the start of the model to either retirement at age 65 or death at age 85. The model was used to compare outcomes for coverage versus no coverage of sustained-release bupropion hydrochloride as a component of a smoking- cessation benefit under four managed care plan scenarios and four employer scenarios. For the managed care scenarios involving coverage of bupropion sustained-release the overall decrease in health care costs over a 20-year period ranged from $7.9 million to $8.8 million; for every dollar spent covering smoking cessation, $4.10- $4.69 in health care costs was saved. For the employer scenarios, health care costs over 20 years decreased by $8.3 million to $14.0 million, and smoking-related indirect costs decreased an additional $5.1 million to $7.7 million; for every dollar spent covering smoking cessation, $5.04- $6.48 was saved.
A model developed to assess the specific costs and benefits of covering sustained-release bupropion hydrochloride as a component of a smoking-cessation benefit indicated cost savings for health plans and employers.
Excess morbidity and mortality of cigarette smokers compared with nonsmokers and former smokers have been observed repeatedly. Relationships between cigarette smoking and various diseases are well documented. Smoking is responsible for nearly one fifth of deaths from cardiovascular disease and for 85% of lung cancer cases, and it is the leading cause of pulmonary disease. Health care expenditures for smokers are significantly higher than for nonsmokers at all ages. In addition, smokers have higher absenteeism and decreased productivity in the workplace. The prevalence of cigarette smoking among the U.S. adult population has decreased over the past few decades but is still about 25%.
Several pharmacologic agents have been developed to assist in smoking cessation. Insurance coverage of these smoking-cessation therapeutic aids is highly variable. In prescription drug benefit design, smoking-cessation benefits have been separated from traditional benefits. Most insurers offer coverage of smoking-cessation products to customers through a rider available for purchase in addition to other medical or prescription drug benefits. The rationale for this separation is concern about the efficacy of smoking- cessation products and the return on the investment. However, this area of health care benefits is receiving more attention. In particular, employers and insurers are closely evaluating the financial impact of providing full coverage of smoking-cessation aids.
Bupropion hydrochloride sustained-release tablets (Zyban SR, Glaxo Wellcome) were recently approved to assist in smoking cessation. A number of studies have found that the sustained-release formulation of bupropion (bupropion SR), by itself or in combination with nicotine-replacement patches, can substantially increase smoking-cessation rates. However, the economic and health care impacts of smoking-cessation programs incorporating bupropion SR have not been assessed. We developed and applied an economic model designed to evaluate the costs and benefits of bupropion SR-based smoking-cessation programs. This model was developed to allow employers and decision-makers at managed care plans and Medicaid programs to assess the impact of coverage of smoking-cessation products.
The development and application of an economic model designed to assess the specific costs and benefits of health plan coverage of smoking-cessation programs involving sustained-release bupropion hydrochloride are described.
A cohort of 100,000 employees or health plan members and 60,000 adult dependents was followed from the start of the model to either retirement at age 65 or death at age 85. The model was used to compare outcomes for coverage versus no coverage of sustained-release bupropion hydrochloride as a component of a smoking- cessation benefit under four managed care plan scenarios and four employer scenarios. For the managed care scenarios involving coverage of bupropion sustained-release the overall decrease in health care costs over a 20-year period ranged from $7.9 million to $8.8 million; for every dollar spent covering smoking cessation, $4.10- $4.69 in health care costs was saved. For the employer scenarios, health care costs over 20 years decreased by $8.3 million to $14.0 million, and smoking-related indirect costs decreased an additional $5.1 million to $7.7 million; for every dollar spent covering smoking cessation, $5.04- $6.48 was saved.
A model developed to assess the specific costs and benefits of covering sustained-release bupropion hydrochloride as a component of a smoking-cessation benefit indicated cost savings for health plans and employers.
Excess morbidity and mortality of cigarette smokers compared with nonsmokers and former smokers have been observed repeatedly. Relationships between cigarette smoking and various diseases are well documented. Smoking is responsible for nearly one fifth of deaths from cardiovascular disease and for 85% of lung cancer cases, and it is the leading cause of pulmonary disease. Health care expenditures for smokers are significantly higher than for nonsmokers at all ages. In addition, smokers have higher absenteeism and decreased productivity in the workplace. The prevalence of cigarette smoking among the U.S. adult population has decreased over the past few decades but is still about 25%.
Several pharmacologic agents have been developed to assist in smoking cessation. Insurance coverage of these smoking-cessation therapeutic aids is highly variable. In prescription drug benefit design, smoking-cessation benefits have been separated from traditional benefits. Most insurers offer coverage of smoking-cessation products to customers through a rider available for purchase in addition to other medical or prescription drug benefits. The rationale for this separation is concern about the efficacy of smoking- cessation products and the return on the investment. However, this area of health care benefits is receiving more attention. In particular, employers and insurers are closely evaluating the financial impact of providing full coverage of smoking-cessation aids.
Bupropion hydrochloride sustained-release tablets (Zyban SR, Glaxo Wellcome) were recently approved to assist in smoking cessation. A number of studies have found that the sustained-release formulation of bupropion (bupropion SR), by itself or in combination with nicotine-replacement patches, can substantially increase smoking-cessation rates. However, the economic and health care impacts of smoking-cessation programs incorporating bupropion SR have not been assessed. We developed and applied an economic model designed to evaluate the costs and benefits of bupropion SR-based smoking-cessation programs. This model was developed to allow employers and decision-makers at managed care plans and Medicaid programs to assess the impact of coverage of smoking-cessation products.
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