Anti-smoking campaign saves Mass. $3 for every $1 spent, study finds

By Kay Lazar, Globe Staff

For every dollar Massachusetts spends on anti-smoking programs for low income residents it saves $3 in medical costs, largely from avoided heart attacks and other cardiac-related hospitalizations, a new study finds.

That translated into an annual net savings of about $14.7 million for the state Medicaid program, according to the research by George Washington University.

State health officials said today that the savings are so robust that they will encourage private insurers to offer a similar smoking cessation program, featuring low co-payments and few restrictions, to all consumers.

The researchers reviewed Medicaid records and an earlier study by another group of scientists who found a nearly 50 percent drop in cardiac-related hospitalizations among residents who participated in the Massachusetts Tobacco Control and Prevention Program from 2007 to 2009.

The latest study, published today in PLoS ONE, an international online medical journal, calculated the cost savings to the state’s Medicaid program from the drop in hospitalizations in just the first 70 weeks after patients began using tobacco cessation medications.

“Most states are saying our budget is really tight now and we don’t want to do anything that will increase costs, but here is something you can do to save money, not 10 years down the line, but save you money next year,” said Leighton Ku, director of the Center for Health Policy Research at George Washington University and the study’s co-author.

The Massachusetts program, started in 2006, allows Medicaid patients to receive nicotine patches, gum, lozenges or medications for co-payments ranging from $1 to $3, and also offers free telephone counseling. Almost 38,000 people a year participated.

Smoking rates are about twice as high among Medicaid recipients nationwide, compared with all adults in the United States. The Massachusetts anti-smoking initiative managed to reach about 40 percent of the smokers in the Medicaid program, and was successful in driving down the numbers from about 38 percent to 28 percent, Ku said.

“We don’t know how long the people stayed off [cigarettes] and I am perfectly willing to believe that many go back to smoking at some point,” Ku said. “People often quit and they are off for a while and they start again, and conceivably after a few tries they may be able to stay off permanently.”

Among those who kicked the habit and hasn’t gone back is 42-year-old New Bedford resident Marcia Campbell, a three-pack-a-day smoker who enrolled in the program after being hospitalized for pneumonia last April.

“Smoking was my best friend,” Campbell said. “I went through a divorce with it.”

But Campbell has a chronic lung disease and other health problems, and her doctor warned her after her hospitalization to quit. She said the smoking cessation program provided nicotine patches, mailed her helpful pamphlets, and had a counselor call her once a week for months.

“It was just somebody to talk to,” Campbell said. “Even if you don’t think it’s possible to quit, sometimes you have to lean on somebody else to get the strength to do it.”

Still it hasn’t been easy. Campbell, who has epilepsy and cerebral palsy, said she has since gained about 100 pounds and is now struggling to lose that weight.

Tobacco control specialists said the savings from the Massachusetts program stand out likely because the state went further than most by heavily publicizing the stop-smoking campaign to patients and physicians.

“That’s where a lot of programs fall short,” said Dr. Michael Fiore,director of the University of Wisconsin Center for Tobacco Research and Intervention. “People aren’t aware that there are programs out there that assist them in quitting.”

Fiore said the Massachusetts program “exceeded our greatest hopes” because there are few public health interventions that can claim such swift success.

“In medicine, that just doesn’t happen,” said Fiore, an internist who chaired three federal panels that reviewed the scientific evidence on the effectiveness of smoking cessation programs and medications, and developed guidelines for health care providers.

Fiore said the Massachusetts program was based on those recommendations.

“Massachusetts has provided a model for something that I believe every state Medicaid office should replicate,” he said.

Massachusetts promoted its Medicaid anti-smoking program when it was launched in 2006, and continued advertisements until January 2008, but funding for promotion has since dried up, said Roger Snow, deputy medical director of of the state’s Medicaid program.

“If we had the money to roll out another publicity campaign we would want to do that because that was a key component of the success,” Snow said.

Lois Keithly, director of the Tobacco Cessation and Prevention Program at the Massachusetts Department of Public Health, said her agency will be pushing for private insurers, and the companies that provide coverage for state and local employees, to adopt similar smoking cessation initiatives. She said a review of those programs found none that was as comprehensive and low cost as the one offered by Medicaid.

“This is a powerful intervention for decreasing health care costs,” Keithly said.

Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.