The association between smoking cessation outpatient visits and total medical costs: a retrospective, observational analysis of Japanese employee-based public health insurance data.

AIMS: The short-term effects of smoking cessation (SC) on overall healthcare costs are unclear. This study aimed to compare the short-term medical costs between patients with SC outpatient visits (SCOVs) and those without SCOVs, consisting of SCOV itself and overall medical costs. MATERIALS AND METHODS: This study is a retrospective, observational study using a Japanese employee-based health insurance claims database (January 1, 2005-December 31, 2013). It analyzed individuals who were registered as smokers based on their medical checkup details. It compared the per-patient-per-year (PPPY) medical costs for male smokers who made ≥1 claim for SCOVs with those who made no claims. We also assessed whether the number of SCOVs by male and female smokers impacted medical costs. The Index Year was the year after the first SCOV claim and that after the first registration as a smoker (non-SCOV group). Medical costs were calculated using regression analysis and adjusted for baseline costs. RESULTS: In Index Year -1, PPPY medical costs for male smokers were ∼USD 323.01 (JPY 36,500, as of November 2017) higher in the SCOV (n = 5,608) vs the non-SCOV (n = 81,721) group; however, by Year 6 the costs were similar. From Year 4-6, PPPY medical costs for SCOVs were lower than those in the adjusted non-SCOV group. For 2,576 male and female smokers in the SCOV group, the average rates of increasing medical costs before and after the SCOV for 1, 2, 3, 4, and 5 SCOVs made were 58%, 44%, 50%, 41%, and 34%, respectively. LIMITATIONS: The database includes limited data on individuals >65 years. Only SCOVs based on claims data and not on other outcomes were assessed. CONCLUSIONS: Medical costs declined in the short-term following the first SCOV. Attendance at a greater number of SCOVs was associated with a lower increase ratio of medical costs.

Attitudes towards passive smoking at restaurants and effects of the provision of information: A comparison between smokers and non-smokers via a web survey.

Objectives　Our objectives were to conduct a web-based survey using adult participants to investigate 1) differences in attitudes towards smoking in the presence of non-smokers between smokers and non-smokers and 2) the potential impact of knowledge regarding the harmful effects of smoking and secondhand smoke (SHS) on smoker behavior in a restaurant.Method　Japanese smokers and non-smokers aged 20 to 69 were separately sampled and both groups were randomly allocated to either a knowledge group or a control group. The participants were asked to complete an online questionnaire to capture their attitudes and how they think they would behave in a restaurant where it was not clear whether smoking is prohibited or not. Data were analyzed using a t-test for numerical variables and a χ2 test for categorical variables. Logistic regression analysis was also conducted to elucidate the factors influencing the smoking behavior near non-smokers.Results　Overall, 2,157 participants were surveyed (smokers, n=1,084; non-smokers, n=1,073). Among smokers who intended to smoke in the restaurant, 24.8% answered that they would ask for permission from nearby persons before lighting up. However, only 2.8% of non-smokers had ever actually been asked for such permission. The percentage of smokers who would smoke in the restaurant was significantly lower in the knowledge group (16.4%) than the control group (22.8%). The most common reason for refraining from smoking was a lack of an ashtray on the table in both groups. Among the non-smokers, 37.4% of the knowledge group and 27.6% of the control group answered that they did not like nearby smoking. A multiple logistic regression analysis revealed that smoking in restaurants was significantly associated with nicotine dependence, household income, pregnancy, smoking place in the home, age, and SHS knowledge.Conclusion　This study suggested that most non-smokers do not inform smokers that they do not like nearby smoking. It was also found that smoking behaviors could be influenced by non-smokers' preference for nearby smoking and by environmental factors such as the presence of an ashtray on the table. Knowledge about the harmful effects of smoking and SHS may influence the attitudes and behavior towards nearby smoking among both smokers and non-smokers.

Examining the association of smoking with work productivity and associated costs in Japan.

AIMS: Smoking is associated with significant health and economic burden globally, including an increased risk of many leading causes of mortality and significant impairments in work productivity. This burden is attenuated by successful tobacco cessation, including reduced risk of disease and improved productivity. The current study aimed to show the benefits of smoking cessation for workplace productivity and decreased costs associated with loss of work impairment. MATERIALS AND METHODS: The data source was the 2011 Japan National Health and Wellness Survey (n = 30,000). Respondents aged 20-64 were used in the analyses (n = 23,738) and were categorized into: current smokers, former smokers, and never smokers. Generalized linear models controlling for demographics and health characteristics examined the relationship of smoking status with the Work Productivity and Activity Impairment questionnaire (WPAI-GH) endpoints, as well as estimated indirect costs. RESULTS: Current smokers reported the greatest overall work impairment, including absenteeism (i.e. work time missed) and presenteeism (i.e. impairment while at work); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on overall work impairment. Current smokers and former smokers had greater activity impairment (i.e. impairment in daily activities) than never smokers. Current smokers reported the highest indirect costs (i.e. costs associated with work impairment); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on indirect costs. LIMITATIONS AND CONCLUSIONS: Smoking exerts a large health and economic burden; however, smoking cessation attenuates this burden. The current study provides important further evidence of this association, with former smokers appearing statistically indistinguishable from never smokers in terms of work productivity loss and associated indirect costs among a large representative sample of Japanese workers. This report highlights the workplace benefits of smoking cessation across productivity markers and cost-savings.

Cost-Effectiveness Analysis of Smoking Cessation Interventions in Japan Using a Discrete-Event Simulation.

BACKGROUND: Smoking cessation medications have been shown to yield higher success rates and sustained abstinence than unassisted quit attempts. In Japan, the treatments available include nicotine replacement therapy (NRT) and varenicline; however, unassisted attempts to quit smoking remain common. OBJECTIVE: The objective of this study was to compare the health and economic consequences in Japan of using pharmacotherapy to support smoking cessation with unassisted attempts and the current mix of strategies used. METHODS: A discrete-event simulation that models lifetime quitting behaviour and includes multiple quit attempts (MQAs) and relapses was adapted for these analyses. The risk of developing smoking-related diseases is estimated based on the duration of abstinence. Data collected from a survey conducted in Japan were used to determine the interventions selected by smokers initiating a quit attempt and the time between MQAs. Direct and indirect costs are assessed (expressed in 2014 Japanese Yen). RESULTS: Using pharmacotherapy (NRT or varenicline) to support quit attempts proved to be dominant when compared with unassisted attempts or the current mix of strategies (most are unassisted). The results of stratified analyses by age imply that smoking cessation improves health outcomes across all generations. Indirect costs due to premature death leading to lost wages are an important component of the total costs, exceeding the direct medical cost estimates. CONCLUSIONS: Increased utilisation of smoking cessation pharmacotherapy to support quit attempts is predicted to lead to an increase in the number of smokers achieving abstinence, and provide improvements in health outcomes over a lifetime with no additional costs.

Web-based survey on smoking cessation behaviors of current and former smokers in Japan.

OBJECTIVE: To investigate the long term smoking cessation behaviors in a population of Japanese current smokers (CS) and former smokers (FS). RESEARCH DESIGN AND METHODS: Retrospective survey of Japanese men and women ≥20 years of age who were CS (those who smoked any number of cigarettes at the time of the survey, 24-27 June 2013) or FS (those who had smoked any number of cigarettes in the past but did not consider themselves smokers at the time of the survey). CS/FS were selected from a prescreened source population recruited by online advertisement that was age- and gender-matched, to represent Japanese smokers. Clinical and socio-demographic characteristics and smoking/smoking cessation history were assessed through a web-based questionnaire. MAIN OUTCOME MEASURES: MAIN OUTCOME MEASURES were number of past quit attempts and time to relapse; others included methods used to achieve smoking cessation, and reasons for wanting to quit. RESULTS: Overall, 1261 Japanese subjects were surveyed (CS, n = 631; FS, n = 630). Nearly half (45.6%) of CS had never attempted to quit smoking. Of those who had attempted to quit smoking, one single quit attempt was the most common for both CS and FS (19.0 vs. 39.0%). Estimated median time to relapse was 105 days (FS and CS combined). Unaided smoking cessation was the most common method both for CS and FS (78.2 vs. 63.4%). CONCLUSIONS: In our survey, >70% of smokers used unaided smoking cessation methods, which may have resulted in a lower success rate. Participants relapsed after a median of 105 days of abstinence (25% within 7 days; the remainder had resumed smoking after 1260 days). As with all surveys, recall bias may have influenced the results. Our observations could be combined with other data in health economic models of smoking cessation to identify appropriate measures to reduce the prevalence of smoking in Japan.

Predictors of lapse and relapse to smoking in successful quitters in a varenicline post hoc analysis in Japanese smokers.

BACKGROUND: The efficacy of the smoking-cessation agent varenicline has been reported in Asian smokers; however, few studies have investigated factors that contribute to lapse and relapse. OBJECTIVE: This post hoc analysis aimed to identify predictors of smoking lapse and relapse. METHODS: This was a post-hoc analysis based on a double-blind, placebo-controlled, randomized, parallel-group study in which Japanese smokers (aged 20-75 years) who smoked ≥ 10 cigarettes/day and were motivated to quit were randomized to receive varenicline (0.25 mg twice daily [BID], 0.5 mg BID, 1 mg BID) or placebo for 12 weeks followed by a 40-week non-treatment follow-up. For inclusion in this analysis, participants must have been nicotine dependent (Tobacco Dependence Screener score ≥ 5) and must have successfully quit smoking continuously for 4 weeks (weeks 9-12). Lapse was defined by answering yes to ≥ 1 question in the Nicotine Use Inventory. Relapse was defined by participants having smoked for ≥ 7 days during follow-up measured by the Nicotine Use Inventory. RESULTS: Of the 619 randomized individuals, 515 had a Tobacco Dependence Screener score of ≥ 5, and 277 quit smoking continuously from weeks 9 to 12. Approximately 75% were male, with a mean (SD) BMI of 23.0 (3.0) kg/m(2). Maximum length of continuous abstinence (CA) during treatment and age (both P < 0.0001) were significant predictors of lapse. Maximum CA (P < 0.0001), age (P = 0.0002), Minnesota Nicotine Withdrawal Scale (MNWS) score for urge to smoke (P = 0.0019), and having made ≥ 1 serious quit attempt (P = 0.0063) were significant predictors of relapse. For participants with a maximum CA of 4 to 6 weeks versus those with a maximum CA of 10 to 11 weeks, the ORs for lapse and relapse were 4.649 (95% CI, 2.071-10.434) and 3.337 (95% CI, 1.538-7.239), respectively. In participants aged 21-34 years versus those aged 47-72 years, the ORs for lapse and relapse were 3.453 (95% CI 1.851, 6.441) and 3.442 (95% CI 1.795, 6.597), respectively. Participants with a MNWS urge to smoke score of 2 to 4 versus 0 had an OR for relapse of 3.175 (95% CI, 1.166-8.644). Participants having made ≥ 1 versus no serious quit attempts had an OR for relapse of 2.108 (95% CI, 1.168-3.805). CONCLUSION: Shorter maximum CA and younger age at quit attempt were associated with increased risk of lapse and relapse. Higher MNWS urge to smoke score and having made ≥ 1 serious quit attempt were associated with increased relapse risk. ClinicalTrials.gov identifier: NCT00139750.