Dr. Culyba

Tuesday, 24 May 2005 09:30

The case for smoking cessation

When smoking is the subject, the news is rarely good. The Centers for Disease Control and Prevention (CDC) considers smoking the leading cause of preventable death in the United States and the producer of one of the most substantial health-related economic costs to society.

The CDC estimates that each year between 1995 and 1999, smoking caused 440,000 premature deaths in the United States and $157 billion in annual health-related economic losses.

Despite the bad news, 22.5 percent of adults smoke. More alarming is a study that shows 26 percent of all high school seniors smoke. In Pittsburgh, the news is even worse -- more women smoke while pregnant in Pittsburgh than in any of the other 50 largest American cities, according to a report from the Annie E. Casey Foundation.

But if you dig deep enough, you can find some good news on this subject. It lies in the peculiar nature of this particular "disease" -- smoking is an avoidable disease. You just have to know how to avoid it.

The most encouraging statistic connected with smoking is that 50 percent of Americans who have ever smoked are now ex-smokers. And most of those succeeded in quitting after failing in multiple attempts. So, quitting smoking can be done.

Employers can help their employees avoid the addiction of smoking by sponsoring smoking cessation programs and offering pharmacy coverage for smoking cessation medications. A survey of the nation's health plans shows that the majority of plans offer at least one type of pharmacotherapy for tobacco cessation.

There are a few striking realities for employers to consider when deciding whether to offer support and encouragement to employees who are trying to quit smoking.

* Smokers incur health care costs 18 percent higher over an 18-month period than those who never smoked.

* Nonsmokers are more productive, take fewer sick days per year and use fewer health care resources than smokers.

"Employers as health care insurance purchasers can have an important role in improving outcomes by ensuring that their insurance plans cover effective tobacco dependence treatments," the Journal of the American Medical Association reported in October 2002.

In recent months, some employers have gained national notoriety by instituting policies that prohibit the hiring of smokers and/or promote the firing of employees who refuse to quit.

Those extreme measures generated controversy, much more controversy than they were worth, at least in terms of effectiveness. Statistics show that harsh measures that "force" employees to stop smoking are almost always ineffective.

Employers who really want to help their employees quit should understand that behavioral change of this type is a process, and that success will not happen overnight. If an employer forces employees to participate in cessation programs, a majority will resist the idea, including those who truly want to quit.

Studies show that while 90 percent of all smokers say they wish they did not smoke, only 10 to 15 percent are actually prepared to quit within a month.

Rather than enforcing behavior change, employers should be prepared to offer assistance to employees who want it, understanding that the employee is the best judge of what method will work for him or her.

You can encourage people by providing economic incentives. The U.S. Department of Health and Human Services says that if tobacco users have access to effective services, they are two to three times more likely to quit. These services include nicotine replacement therapies such as the patch, gum, lozenges, inhalers and the non-nicotine medication Zyban.

At most workplaces, anywhere from 14 percent to 40 percent of employees are smokers. About 10 percent to 15 percent of them will try to quit. Only about half of those who try will succeed. Those who do quit extend their lives by an average of 7.1 years.

Are smoking cessation programs worth it? It's hard to imagine how any health promotion program could be worth more.

Michael Culyba is vice president of medical affairs for UPMC Health Plan. The Health Plan, with more than 435,000 members, is part of the University of Pittsburgh Medical Center's integrated medical delivery system and is the only provider-led health plan in western Pennsylvania. Reach Culyba at (412) 454-5210.

Friday, 31 May 2002 13:05

Rx for cost control

An increasing number of Americans are crossing international borders in search of a good drug deal.

But these deals are perfectly legal and nothing more than an effort by prescription drug users to decrease their costs for pharmaceuticals.

The cost of widely used drugs continues to increase at double-digit rates, resulting in dramatically higher health care premium costs. And as drug costs rise, they are becoming a larger part of workers' total benefits packages, resulting in pay cuts or a reduction of other benefits as a percentage of total compensation.

Some newly developed drugs backed by expensive advertising campaigns don't have much more effect than drugs that have been successfully used for years. But as a result of advertising, patients are demanding these drugs, and costs are escalating.

If this continues, employers may be forced to decide between raising co-payments and putting in place more restrictive formularies to reduce costs.

While business associations have their say in the nation's capital on health care issues, it may seem there is little an individual company can do to combat rising drug costs. There are, however, ways to decrease drug costs.

The medical staff at UPMC Health Plan offers several suggestions for companies that want to be proactive:

* Have frank discussions with employees about drug costs and their effect on insurance rates, and ask them to always discuss the availability of generic drugs with their doctor. UPMC Health Plan's pharmacy department estimates that doctors switching just 5 percent of prescriptions to generic brands could save about $4.5 million annually in its network alone.

* Encourage employees to become familiar with their insurance company's drug program and discuss these benefits with their doctors. At UPMC Health Plan, for instance, one program sets low co-payments for generic drugs, a slightly higher co-payment for preferred drugs with no generic equivalent and the highest co-payment for nonpreferred brand-name drugs.

* Ask employees to consider using mail-order services when appropriate. These often save money for patients, and the discounts are better than retail pharmacy discounts, which helps employers and health plans manage the premium dollar. Dr. Michael J. Culyba is vice president, medical affairs, for UPMC Health Plan.