Why Payors Should Help Members Quit Smoking

Disease and death burden is still significant and exacerbates COVID-19

BRIEFING
November 10, 2021
Senior Medical Director, CVS Caremark
Vice President, Enterprise Patient Safety

During the COVID-19 pandemic, cigarette sales rose for the first time in two decades.https://www.ftc.gov/news-events/press-releases/2021/10/ftc-report-finds-annual-cigarette-sales-increased-first-time-20 While smoking may have temporarily been out of the spotlight due to other public health crises, it remains a serious threat to member health and payors’ bottom lines.

Tobacco use continues to be the leading cause of preventable disease and disability in the United States. Recent data shows that approximately 40 million U.S. adults continue to smoke cigarettes. Half a million Americans die prematurely of smoking or exposure to secondhand smoke every year. Another 16 million suffer from serious illness caused by smoking.

Smoking leads to disease, disability, and harms every organ of the body.https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm For every person who dies because of smoking, at least 30 people live with a serious smoking-related illness.

  • Smoking causes cancer, heart disease, stroke, lung disease, diabetes and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis
  • Smoking also increases the risk of tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis
  • Smoking is a known cause of erectile dysfunction in males

Cigarette smoking is responsible for 13,000 daily deaths or one in five deaths every year (more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure).

  • On average, smokers die 10 years earlier than nonsmokers
  • At the current rate, one in every 13 Americans age 17 years or younger is expected to die prematurely from a smoking-related illness (5.6 million of today’s Americans younger than 18 years of age)

The total economic cost of smoking is more than $300 billion (about $920 per person) a year, including more than $225 billion (about $690 per person) in direct medical care for adultshttps://www.sciencedirect.com/science/article/abs/pii/S0091743521001134?via%3Dihub and more than $156 billion (about $480 per person) in lost productivity due to premature death and exposure to secondhand smoke. Each year, the United States spends more than $225 billion on medical care to treat smoking-related disease in adults.https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm

Smoking increases the risk of severe illness and death from COVID-19

COVID-19 offers yet another good reason to quit smoking. Cigarette smoke damages lung function and impairs the immune system, which increases the risk of respiratory infections and makes it harder for the body to fight off coronavirus.https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930239-3

Studies associate smoking with worse COVID-19 outcomes and severe illness resulting in hospitalization, intensive care, mechanical ventilation or even death.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284674/

  • Current smokers were 1.45 times more likely to have severe complications compared to former and never smokers, and a higher mortality rate of 38.5 percenthttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233147
  • Young adults who smoke or vape are five to seven times more likely to contract COVID-19 and to experience more serious symptomshttps://www.jahonline.org/article/S1054-139X(20)30399-2/fulltext

Smoking reduces the effectiveness of expensive, cutting-edge therapies

In addition to increasing the risk of cancer, smoking can negatively affect cancer treatment, symptoms, side effects and survival.https://jnccn.org/view/journals/jnccn/14/11/article-p1430.xml?print According to the Office of the U.S. Surgeon General, smoking increases the failure rate of treatments for all types of cancer, making treatments more toxic or less effective.https://www.hhs.gov/surgeongeneral/reports-and-publications/tobacco/consequences-smoking-factsheet/index.html And smokers, who have a significantly greater symptom burden, can experience interruptions in treatment, reductions in dosages and delays in therapy — all of which result in lower treatment efficacy and lower quality of life.

Cigarette smoking also can increase the chance of cancer recurrence or secondary cancer.https://jnccn.org/view/journals/jnccn/14/11/article-p1430.xml?print In the Surgeon General's Report, 82 percent of reviewed studies linked smoking and risk of recurrence.

  • Tobacco use causes at least 30 percent of all cancer deathshttps://www.cancer.org/healthy/stay-away-from-tobacco/health-risks-of-tobacco/health-risks-of-smoking-tobacco.html#:~:text=Smoking%20causes%20about%2020%25%20of,deaths%2C%20are%20due%20to%20smoking.
  • For lung cancer patients, current tobacco use was associated with a significant increase in death compared with those who quit. Lung cancer patients who stopped smoking at or following their diagnosis had a median 9-month improvement in overall survivalhttps://www.sciencedirect.com/science/article/pii/S1556086415334882

Evidence also suggests the financial effects of smoking among cancer patients can be significant. According to an article in JAMA, “The cost estimates for first-line cancer treatment failure attributed to smoking ranged from $10,000 to $250,000.”https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729798 With 1.6 million patients diagnosed with cancer annually, continued smoking could lead to $3.4 billion in incremental costs for subsequent cancer treatments.

In addition to cancers, research shows smoking may worsen the disease progression and increases the failure rate of treatments for multiple sclerosis and autoimmune conditions like rheumatoid arthritis, along with the subsequent impact on cost of care.https://www.amjmed.com/article/S0002-9343(20)30228-X/fulltext

Plan sponsors can provide crucial support to help members stop smoking

All individuals who smoke cigarettes should be advised to quit. Even brief advice to quit has been shown to increase quit rates. The addictive nature of tobacco, the discomfort of withdrawal, weight gain and environmental factors associated with the act of smoking all play a role in making quitting a difficult and daunting task. People can differ in the way in which they smoke, their success in quitting, symptoms they have when trying to quit and factors that may lead to relapse.

Payors can provide a vital link connecting plan members who smoke with therapy and support to quit smoking. Effective techniques include pharmacotherapy and behavioral support.

Changing behaviors and taking medication are the two main methods of quitting smoking. Using both methods together increase the chances of quitting successfully.

Pharmacotherapy

There are several medications that can help stop smoking; in the United States, some of these are available without a prescription while others require a prescription. Effective medications include nicotine gum, patches or lozenges (available over the counter) and the prescription medication bupropion (brand names: Zyban, Wellbutrin).

Behavioral support

Stopping smoking can be tough, but it’s easier with support. The American Lung Association has lots of options to help people quit smoking for good.

Helping smokers quit also means a healthier bottom line

About 70 percent of current smokers’ excess medical care costs can be prevented.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597893/ Smoking cessation programs are among the most cost-effective benefits that health plans and employers can offer — and they truly pay off with better health and financial outcomes. This includes cost savings related to reduced morbidity and mortality, improvement of smoking-related illness and increased workplace productivity.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690372/

  • Smoking cessation interventions for pregnant women that cost $25 to $35 accrue cost savings of $881 per personhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525265/
  • The costs of smoking cessation programs can be fully offset by health care cost savings within three years and ROI continues to grow over the next decadehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052927/
  • For every $1 spent on cessation treatments, employers could save $1.90 to $5.75Washington Economics Group, Inc. The Net Benefits and Economic Impacts of Investing in Employee Smoking Cessation Programs in the Public and Private Sectors of Florida. March 6, 2008.

What’s more, smoking cessation can bring down health care costs for everyone. If 10 percent of American smokers quit and the rest cut back just 10 percent, the United States could trim medical costs by $63 billion the following year, according to one analysis.https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002021

CVS Health has resources to help members quit

CVS Health, which removed tobacco products from all CVS Pharmacy locations in 2014, is committed to helping deliver the nation’s first tobacco-free generation. We are investing in efforts to increase access to anti-smoking education, tobacco control advocacy and healthy behavior programming. Explore key resources for students, parents, teachers, clinicians, schools and youth organizations.

Want to learn how to help your plan members quit smoking for good? Ask Us
BRIEFING
November 10, 2021
Senior Medical Director, CVS Caremark
Vice President, Enterprise Patient Safety

The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health. This page contains trademarks or registered trademarks of CVS Pharmacy, Inc. and/or one of its affiliates.

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