Reducing financial barrier of smoking cessation treatment can effectively enhance prolonged abstinence: an experience from Taiwan

Abstract

Background and challenges to implementation: Taiwan has established nationwide smoking cessation treatment service which was founded by the revenue of cigarette taxation since 2002. The government reimburses physician counseling and subsidizes pharmacotherapy for adult smokers attempting to quit. The initial subsidy, 250 Taiwan dollars per week, accounted for only 20-35% cost of effective treatment. Lack of financial incentive was commonly recognized as a major barrier for smokers to use service. Intervention or response: In March 2011, the government introduced a new policy to reduce financial barrier to cessation service. Smoker was responsible for 20% of drug cost, with a ceiling copayment of 200 Taiwan dollars for each prescription (1- to 4-week ). This observational study aims to evaluate the effectiveness of new financing policy on service utilization and cessation outcome among adult smokers. We compare the selfreported 7-day point abstinence and 30-day prolonged abstinence by telephone interview among participants from 2008-2014. Results and lessons learnt: A total of 582,281 smokers enrolled in cessation service from 2008-2014. Of them, 174,844 received telephone interview and 107,358 (61.4%) completed the interview. After introducing new financing policy, the number of smokers enrolling in cessation treatment service increased 42.3% between Mar-Dec 2011 and Mar-Dec 2012. The 30-day prolonged abstinence rates at 6 months significantly increased from 21.3% to 25.4% (difference=4.1%, 95% CI 3.5%-4.6%) after implementing new policy, with an adjusted OR=1.26 (95% CI 1.21-1.30). The 7-day point abstinence increased from 23.0% to 27.0% (difference=4.0%, 95% CI 3.4%-4.6%), with an adjusted OR=1.24 (95% CI 1.20-1.28). Conclusions and key recommendations: Cessation treatment is an effective intervention for addictive smokers. Access to treatment and cessation outcome can be significantly promoted by reducing financing barrier. Smoker's affordability and willingness-to-pay should be evaluated in offering cessation service.