RCT of tobacco dependence treatment benefits in an HMO &amp; PPO
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: The overall objective of the proposed experiment is to study the impact of first-dollar coverage of a comprehensive smoking cessation benefit for the 2001 benefit year for smokers enrolled in Blue Shield of California’s HMO and PPO plans. The research will have direct policy relevance for increasing access to tobacco dependence treatments for approximately 75% of California’s insured population who receive their health care through HMOs and PPOs. The goal of the research is to define health insurance benefits that remove barriers to access to the most effective smoking cessation treatments and help smokers to quit.
 
 
 
 
 
 
 
 The smoking cessation treatments that will be covered include a smoking cessation telephone counseling service and Federal Food and Drug Administration (FDA) approved pharmacotherapy, including nicotine gum and patch, and Zyban (bupropion/Wellbutrin). 
 
 
 
 
 
 The specific research questions to be answered include: 
 
 1. Does the benefit increase use of specific smoking cessation treatments in HMOs and PPOs? 
 
 2. Does the benefit increase quit attempts in HMOs and PPOs? 
 
 3. Does the benefit increase quit rates at 6 and 12 months in HMOs and PPOs ? 
 
 4. Does the benefit increase provider advice to quit and referrals to tobacco dependence treatments in HMOs and PPOs? 
 
 5. What is the cost-effectiveness of the benefit in HMOs and PPOs?
 
 6. What is the total annual cost of the benefit per member per month (pmpm) in HMOs and PPOs?
 
 
 
 
 
 Blue Shield of California has agreed to participate in the research. Using a list of members provided by the health plan, participants in the research will be recruited by telephone. Prior to recruitment, potential participants in Blue Shield’s HMO and PPO will be randomly assigned to either the treatment or control group. The treatment group will receive full coverage for the comprehensive smoking cessation treatment benefit and their primary care physicians will be notified that they have been selected to receive the benefit. At the time of recruitment, the baseline survey will be administered and all participants will be sent a smoking cessation self-help kit, an informed consent letter, and a $5 incentive to return the consent letter. 
 
 
 
 
 
 
 
 Two follow-up phone interviews will be conducted at 6 and 12 months with all study members to ask if they used the telephone counseling, used the drug benefits tried to quit, and successfully quit smoking. The final number of participants completing all interviews is estimated to be 1,600 or 800 smokers per group (400 HMO control/400 PPO control, and 400 HMO treatment/400 PPO treatment). All orders for nicotine gum and patch and Zyban will be tracked through the plans' pharmacy mail order system. 
 
 
 
 
 
 The effects of the benefit for smokers in HMOs and PPOs will be measured in two ways:
 
 1. Estimating the differences in the effects for the treatment and control groups at 6 and 12 months;
 
 2. The cost per benefit user who quits will be estimated from the health plan’s perspective based on the total cost of providing the benefit and the number of smokers in the treatment group who successfully quit. In addition, the cost per member per month (pmpm) will be estimated for smokers in HMOs and PPOs.