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Author List:
Lee BY (CHERP)
Volpp KG (CHERP)
Objectives:
Quantifying potential savings in future health care expenditures from increasing tobacco cessation rates within the national Veterans Affairs (VA) patient population.
Methods:
A series of Markov models simulated the decision to quit smoking at age 30, 40, 50, or 60 for users of the VA Health System and generated the expected lifetime cost-savings of getting an individual to quit smoking from the VA (i.e., payor) perspective. To maximize applicability to other health sytems, the models assumed the VA would cover a patient’s health care expenditures to age 65 at which time Medicare would cover expenditures. After each one-year cycle, patients could end up alive or dead (an absorptive state). Cost data came from the 2002 National VA Budget; a 1999 VA survey (numbers of current and ex-smokers); and age-and sex-adjusted estimates of the fraction of health expenditures attributable to smoking from the National Medical Expenditure Survey. Probabilities came from the Human Mortality Database and the Cancer Prevention Study II. The base case scenario assumed that smoking related expenditures would decrease to half that of current smokers 10 years after quitting. A discount rate of 3% adjusted all future costs to 2002 dollars.
Results:
When no change in life expectancy was assumed, cost savings resulted for quitting at all ages, $5796 (for quitting at age 30), $5870 (age 40), $3558 (age 50), and $641 (age 60), and sensitivity analyses revealed cost-savings in all scenarios. If we accounted for life expectancy changes, smokers quitting at all ages experienced life expectancy gains ranging from 10 years at age 30 to 3 years at age 60. Lifetime health care costs increased in many subgroups. Life expectancy gains occurred in the most conservative estimates for $102 per year.
Implications:
More aggressive smoking cessation could result in significant cost savings to VA payers if life expectancy is held constant. Alternatively, significant life expectancy increases could result for a cost of approximately $600 per year or less allowing life expectancy to vary.
Impacts:
Further thought should be given as to whether payers and employers collectively are underinvesting in smoking cessation efforts for persons under the age of 65.
