A pragmatic, randomized, controlled study evaluating the impact of access to smoking cessation pharmacotherapy coverage on the proportion of successful quitters in a Canadian population of smokers motivated to quit (ACCESSATION)

BMC Public Health

Suzanne Ranger²  Carmen Arteaga¹  Vincent Raymond³  Paul Oh⁵  Gerald Brosky⁶  Peter Selby⁴ 

[1] Chantix/Champix Project Statistical Lead, Pfizer Inc, New York, NY, USA;Pfizer Canada Inc, Kirkland, Québec, Canada;Health Economics and Outcomes Research, Pfizer Canada Inc, Kirkland, Québec,Canada;Ontario Tobacco Research Unit, Toronto, Ontario, Canada;Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Canada;Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

关键词: Varenicline;    Smoking cessation;    Reimbursement;    Pragmatic;    Policy;    Pharmacotherapy coverage;    Nicotine;    Medications;    Clinical trial;    Bupropion;   

Others  :  1131449
DOI  :  10.1186/1471-2458-14-433

 received in 2013-10-04, accepted in 2014-04-29,  发布年份 2014

【 摘 要 】

Background

Many smokers find the cost of smoking cessation medications a barrier. Financial coverage for these medications increases utilization of pharmacotherapies. This study assesses whether financial coverage increases the proportion of successful quitters.

Methods

A pragmatic, open-label, randomized, controlled trial was conducted in 58 Canadian sites between March 2009 and September 2010. Smokers (≥10 cigarettes/day) without insurance coverage who were motivated to quit within 14 days were randomized (1:1) in a blinded manner to receive either full coverage eligibility for 26 weeks or no coverage. Pharmacotherapies covered were varenicline, bupropion, or nicotine patches/gum. Investigators/subjects were unblinded to study group assignment after randomization and prior to choosing a smoking cessation method(s). All subjects received brief smoking cessation counseling. The primary outcome measure was self-reported 7-day point prevalence of abstinence (PPA) at week 26.

Results

Of the 1380 randomized subjects (coverage, 696; no coverage, 684), 682 (98.0%) and 435 (63.6%), respectively, were dispensed at least one smoking cessation medication dose. The 7-day PPA at week 26 was higher in the full coverage versus no coverage group: 20.8% (n = 145) and 13.9% (n = 95), respectively; odds ratio (OR) = 1.64, 95% confidence interval (CI) 1.23–2.18; p = 0.001. Urine cotinine-confirmed 7-day PPA at week 26 was 15.7% (n = 109) and 10.1% (n = 69), respectively; OR = 1.68, 95% CI 1.21–2.33; p = 0.002. After pharmacotherapy, coverage eligibility was withdrawn from the full coverage group, continuous abstinence between weeks 26 and 52 was 6.6% (n = 46) and 5.6% (n = 38), in the full coverage and no coverage groups, respectively; OR = 1.19, 95% CI 0.76–1.87; p = 0.439.

Conclusions

In this study, the adoption of a smoking cessation medication coverage drug policy was an effective intervention to improve 26-week quit rates in Canada. The advantages were lost once coverage was discontinued. Further study is required on the duration of coverage to prevent relapse to smoking. (clinicaltrials.gov identifier: NCT00818207; the study was sponsored by Pfizer Inc.).

【 授权许可】

   
2014 Selby et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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