Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration

Duffy, Susan; Ignacio, Rosalinda V.; Kim, Hyungjin Myra; Geraci, Mark C.; Essenmacher, Carol; Hall, Stephanie; Chow, Andrea W.; Pfeiffer, P.; Sherman, Scott E.; Bohnert, Kipling M.; Zivin, Kara

doi:10.1136/tobaccocontrol-2018-054473

Cited by 4 publications

(7 citation statements)

References 52 publications

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“…The total of these exceeds 23.7% because of observations that were missing more than one item. A companion paper indicated that those excluded were significantly less likely to have initiated pharmacotherapy and more likely to be younger, male, non-White, Hispanic, have less psychiatric and medical comorbidities, have died during the follow-up period (all p<0.05) 12 . The final cohort for analysis included 76.3% 639507/838309) of Veterans who screened positive for tobacco use and who did not use pharmacotherapy in the prior year.…”

Section: Methodsmentioning

confidence: 99%

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Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration

et al. 2021

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INTRODUCTION While initiation rates of tobacco cessation pharmacotherapy have improved both inside and outside the Department of Veteran Affairs (VA), prescribing rates remain low. The objective of this study was to examine correlation of the characteristics of providers, clinics, and facilities with initiation of tobacco cessation pharmacotherapy. METHODS This retrospective, observational study used VA outpatient electronic medical record data from federal fiscal year 2011. Logistic regression models estimated the adjusted odds ratio associated with provider characteristics for pharmacotherapy initiation. RESULTS For the 639507 veterans who used tobacco, there were 30388 providers caring for them. Younger (p<0.001) and female (p<0.001) providers were more likely to initiate tobacco cessation pharmacotherapy. Compared to physicians, pharmacists were 74% more likely to initiate pharmacotherapy, while all groups of nurses were 5–8% and physicians’ assistants were 12% less likely (p<0.001). Compared to those seen in primary care clinics, patients assessed in substance use treatment clinics were 16% more likely to have pharmacotherapy initiated (p<0.001), while those in psychiatry were 10% less likely (p<0.001), and those in outpatient surgery were 39% less likely to initiate pharmacotherapy (p<0.001). Compared to almost all other classes of VA facilities, patients seen in primary care community-based outpatient clinics (CBOCs) were 7–28% more likely to initiate pharmacotherapy (p<0.0001). CONCLUSIONS While the VA is at the leading edge of providing tobacco cessation pharmacotherapy, targeting quality improvement efforts towards providers, clinics, and facilities with low prescribing rates will be essential to continue the declining rates of tobacco use among VA patients.

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Section: Methodsmentioning

confidence: 99%

“…The IRB approved only retrospective use of data from the time of initial IRB approval in 2013. Hence, this study used veterans who were assessed in FY 2011 and followed for 18 months to find the effectiveness of cessation pharmacotherapy 12 .…”

Section: Methodsmentioning

confidence: 99%

Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration

et al. 2021

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“…Of 838 309 tobacco users without pharmacotherapy in the prior year, 53 218 (6.3%) were excluded because of missing data (chiefly race or ethnicity) and 195 229 (23.3%) were excluded because there was no follow-up tobacco use assessment. Complete details on the cohort are reported in an earlier paper on pharmacotherapy effectiveness [17].…”

Section: Samplementioning

confidence: 99%

“…Approximately 6% of the potential cohort was excluded because data for race were missing. Sensitivity analyses involving alternative criteria for defining bupropion for tobacco cessation, and including observations with missing data on race (and excluding race from the covariates), showed little effect on the estimate of treatment effectiveness [17]. These sensitivity analyses were not repeated for this costeffectiveness study.…”

Section: Percentage Of Individualsmentioning

confidence: 99%

“…The United States Veterans Health Administration (VHA) expanded its tobacco cessation program in 2004, increasing the percentage of tobacco using patients who received a pharmacotherapy from 13.8% in 2004 to 26.8% in 2008 [16]. In a recent study published in Tobacco Control, we studied 589 862 veterans who screened positive for tobacco use at VHA in 2011 and found that (controlling for case-mix and confounding by indication) quit rates for those who received pharmacotherapy were significantly higher than that in those who were not treated, 19.8 versus 16.7% (P < 0.001) [17]. In the current paper, we test the hypothesis that tobacco cessation pharmacotherapy is cost-effective in the real-world setting of VHA.…”

Section: Introductionmentioning

confidence: 95%

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Cost‐effectiveness of real‐world administration of tobacco pharmacotherapy in the United States Veterans Health Administration

et al. 2019

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Background and aims Cost-effectiveness studies in randomized clinical trials have shown that tobacco cessation pharmacotherapy is among the most cost-effective of health-care interventions. Clinical trial eligibility criteria and treatment protocols may not be followed in actual practice. This study aimed to determine whether tobacco cessation pharmacotherapy is cost-effective in real-world settings. Design A retrospective analysis of costs and outcomes. Setting Hospitals and clinics of the US Veterans Health Administration, USA. Participants A total of 589 862 US veterans who screened positive for tobacco use in 2011. Intervention and comparator Tobacco users who initiated smoking cessation pharmacotherapy in the 6 months after screening were compared with those who did not use pharmacotherapy in this period. Pharmacotherapy included nicotine replacement therapy, bupropion (if prescribed at 300 mg per day or specifically for tobacco cessation) or varenicline. Measures Effectiveness was determined from responses to a subsequent tobacco screening conducted between 7 and 18 months after the treatment observation period. Cost of medications and prescribing health-care encounters was determined for the period between initial and follow-up tobacco use screening. Multivariate fixed-effects regression was used to assess the effect of initial treatment status on cost and outcome while controlling for differences in case-mix with propensity weighting to adjust for confounding by indication. Findings Thirteen per cent of participants received tobacco cessation pharmacotherapy within 6 months of initial screening. After an average of an additional 218.1 days' follow-up, those who initially received pharmacotherapy incurred $143.79 in additional treatment cost and had a 3.1% absolute increase in tobacco quit rates compared with those who were not initially treated. This represents an incremental cost-effectiveness ratio of $4705 per quit. The upper limit of the 99.

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Receipt of Smoking Cessation Medications and Smoking Abstinence Among Veterans Prescribed Opioid Analgesics With and Without Cannabis Use

Nguyen,

Leonard,

Cohen

et al. 2024

J GEN INTERN MED

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Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration

Abstract: The increased quit rates among Veterans treated support the effectiveness and continuation of the VHA tobacco cessation pharmacotherapy policy.

Cited by 4 publications

References 52 publications

Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration

Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration

Cost‐effectiveness of real‐world administration of tobacco pharmacotherapy in the United States Veterans Health Administration

Receipt of Smoking Cessation Medications and Smoking Abstinence Among Veterans Prescribed Opioid Analgesics With and Without Cannabis Use

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