Tobacco use and treatment options

2021 Q3 Rx Newsletter

October 2, 2021

As of 2021, tobacco use is the leading cause of preventable disease, disability, and death in the United States.

Cigarette smoking is still widespread with an estimated 34 million Americans smoking regularly. Each year, the U.S. spends more than $225 billion on medical care to treat smoking-related disease in adults. Although the majority report wanting to quit, unfortunately, only a small percentage of smokers succeed, resulting in the common question, why?

In 2021, tobacco use, primarily in the form of smoking cigarettes, is still very common for many Americans. While overall usage is down dramatically from the per-capita highs of the 1960’s, we still face tremendous challenges in not only securing more victories against tobacco use, but also immense pressure in protecting the progress that has been achieved so far.

  • According to CDC data, in 2019 alone there was an estimated 34 million American cigarette smokers, of which, 23 million reported wanting to quit smoking entirely.
    •  In addition, of those 23 million, 21.5 million smokers reported making an attempt in the past year to quit smoking. However, only 2.9 million of those smokers succeeded in quitting.
  • These statistics are relatively similar to the trends we see in young Americans, with 3.3 million report attempting to quit using all tobacco products in the past year.
    • While data on young American’s effectiveness in attempts to quit is unavailable, there is little reason to expect that their outcomes are better, if not worse, than their adult counterparts.

What this data shows is that the primary challenges facing public health policy and tobacco cessation efforts is not a lack of interest, determination, or willpower, but instead a failure to focus on the importance of medical and pharmaceutical intervention and therapy in achieving cessation.

  • The CDC data further reinforces this point by stating that in 2015, “only 31.2% (7.6 million) reported using counseling or medication when trying to quit”, when combined with the data that “in 2015, 57.2% of adult smokers (18.8 million) who had seen a health professional in the past year reported receiving advice to quit”. The data paints a rather clear image of a very powerful point of intervention—the primary care physician (PCP)—not being utilized effectively in both public health policy and in employer-sponsored population health management.
  • The data further suggests that “even brief advice to quit (<3 minutes) from a physician improves cessation rates and is highly cost-effective.”

An Employer’s Role and Opportunity in Cessation and Treatment Options

Employer-sponsored health benefits create a unique environment where employers are not only paying the majority of the direct cost of the co-morbidities associated with tobacco use, but also one in which the opportunity for intervention towards employees and members can result in healthier, happier, and ultimately a more productive employee population.

Tobacco cessation is not a one size fits all approach. The most successful smoking cessation programs are tailored to an individual’s needs and utilize a combination of clinician counseling, behavioral reinforcement, community resources, technology support tools, and medication therapy (both nicotine-based and non-nicotine medications). Treatments that can lessen cravings include nicotine replacement skin patches, lozenges, gum, inhalers, or nasal sprays. Non-nicotine medication, such as varenicline (Chantix) can help reduce nicotine withdrawal symptoms, often a primary barrier to smoking cessation, by mimicking how nicotine functions in your body.

  • Drugs such as CHANTIX often fall under the preferred brand/non-preferred brand tier on a formulary, meaning that depending on the tobacco usage in an employer population, a holistic approach to cessation, including CHANTIX or other smoking cessation aids can result in a notable increase in employer Rx related spend. While some generics are available, the generic for Chantix has been in short supply since release, meaning most members are still filling the brand medication.

Smoking cessation is a measurable and achievable goal for both individuals and employers managing their population health. However, a holistic and realistic approach using all available points and types of interventions is essential to achieving tangible outcomes. The effectiveness of cessation cannot just be how many smokers attempt to quit. Instead we must also be mindful of those who attempt, how many succeed, and of those who fail, how many try again.