About the Study – FAQs

Who was involved in the study?
Researchers at Penn State University conducted this nationwide cost-benefit analysis.  The American Lung Association is pleased to share the study’s important results.  Funding for the Penn State research was provided through an unrestricted research grant from Pfizer, Inc. and funding for this project was made possible through collaboration with Pfizer, Inc.

What does smoking cessation mean?
Smoking cessation means to stop smoking tobacco products, including cigarettes.  Smoking cessation is a subset of the Tobacco cessation policies that are federal, state and local policies that encourage or help people to quit using tobacco products, like policies that ensure those who smoke cigarettes have access to evidence-based treatments to help them quit.

Why is smoking cessation important?
Each year in the U.S. more than 393,000 people die from smoking-related disease, making it the leading cause of preventable death. Quitting smoking is the single most important step a smoker can take to improve the length and quality of his or her life. Quitting smoking and other tobacco products not only saves lives, it saves money--for smokers, employers, taxpayers and state governments.

What medications work to help smokers quit?
Quitting smoking and tobacco products is hard, and most smokers need help to do it. Seven medications and three types of behavioral have been proven effective in helping tobacco users quit. Nicotine replacement therapies (NRTs) are available over-the-counter (patch, gum, lozenge) and by prescription (patch, nasal spray, inhaler.) There are also two non-nicotine, prescription-only medications FDA approved to help tobacco users quit.

Does counseling help people quit?
Counseling, or “coaching” helps lots of people quit using tobacco products.  Three types of counseling are recommended as effective for helping people quit: individual (face-to-face), group and phone counseling. Cessation counseling can enhance the effectiveness of cessation medications, but is also effective on its own.

What did the Penn State researchers investigate?
The Penn State researchers set out to determine if  overall there were financial advantages to states offering smoking cessation treatments that outweighed the cost of the treatments plus any losses to state tax revenues and to retailers from fewer people smoking.

What were the results of the study?
The researchers concluded that for most of the smoking cessation treatment options, the overall benefits outweigh the costs to the society of a state.  Using baseline results, on average states could see a return of up to 87 percent, depending on treatment option.

What are the overall costs of smoking to society?
The researchers also calculated that annual direct costs to the U.S. economy that are attributable to smoking add up to more than $301 billion a year. They include workplace productivity losses of about $67.5 billion, costs of premature death at $117 billion and direct medical expenditures of $116 billion.

What is the calculated cost to society of a single pack of cigarettes?
A pack of cigarettes sells at an average retail price of $5.51 in the U.S. When researchers added up the combined medical costs and workplace productivity losses attributable to a single pack of cigarettes consumed, the overall cost to society came to $18.05 per pack.

What is a cost-benefit ratio?
Cost-benefit analysis is a method of economic evaluation that asks whether the costs of an intervention can be justified by the value of the benefits it provides. Both costs and benefits are presented in dollars, making it possible to do a comparison.

What specific factors did the Penn State analysis take into account?
For costs, it took into account the cessation treatment costs, plus the lost tax revenue to the public sector due to fewer people buying cigarettes and also lost retail revenue in the private sector. For benefits, it considered lower medical costs due to fewer people smoking, increased productivity in the workplace and reduced absenteeism and premature death due to smoking.

What specific treatment products did the study consider?
It considered four treatment options, including non-nicotine prescription treatment options  and the nicotine replacement lozenge. The lozenge treatment is similar in cost to other nicotine replacement therapies such as patches and gum.  They analyzed each of the treatment options in a cessation benefit with and without individual counseling. 

How was the return on investment number calculated?
The cost-benefit ratios presented in American Lung Association materials represent a weighted average of the ratios for each treatment option with counseling.  The average was weighted according to treatment utilization percentages obtained from IMS National Prescription Audit (NPA) and AC Nielsen data.

What were the study’s primary findings?
The analysts looked at “baseline” results, meaning the most common findings across all research studies for the level of effectiveness of a cessation treatment. Each medication option provided with counseling represents resulted in a positive return on investment – from 2 cents per every dollar spent, up to 87 cents per every dollar spent.

Are states doing enough to help smokers quit?
No, states are not doing enough to cover smoking cessation treatments according to research conducted by the American Lung Association. Only six states provide comprehensive coverage for Medicaid recipients: Indiana, Massachusetts, Minnesota, Nevada, Oregon and Pennsylvania. Only five states provide comprehensive cessation coverage for state employees: Illinois, Maine, Nevada, North Dakota and New Mexico according to ALA’s research.

Did the federal government’s health care overhaul provide coverage to everyone for tobacco cessation?
The Patient Protection and Affordable Care Act requires some level of cessation coverage in most private plans, for pregnant women enrolled in Medicaid and for the state exchanges.  However, people on Medicaid who are not pregnant are not guaranteed coverage of cessation treatments. State policymakers, by taking action, can ensure that all the treatments are available to everyone in a state.

What does the American Lung Association advocate?
The American Lung Association urges every state to provide all Medicaid recipients and state employees with comprehensive, easily accessible tobacco cessation medications and counseling. A comprehensive cessation benefit includes all seven medications and three types of counseling recommended by the U.S. Public Health Service for tobacco cessation.
 The Lung Association recommends that private insurance plans and employers also offer comprehensive cessation coverage and encourages states to require them to cover these treatments. Only seven states have such requirements now.

Why is the American Lung Association distributing the findings of the Penn State study?
It is a priority of the American Lung Association to increase the number of smokers who can have access to cessation treatment and who can afford it. While the health benefits of tobacco cessation are widely known, there is less information available about the economic benefits. This study provides important information on costs and benefits on a state-by-state basis, which is extremely useful information for policymakers and advocates.  The study also is timely, as fiscally strapped states are hunting for ways to save money and the nation is beginning to implement health care reform.

Where can I read the entire report and the state-by-state data?
You can find the entire report and the state-by-state data online at www.lung.org/cessationcoverage.


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