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Warning "no smoking'' written by a chalk on a blackboard

Want Help To Kick The Habit? It’ll Cost You

By Eric Van De Graaff, MD July 13, 2009 Posted in: Heart Health

No surprise here, smoking is very expensive and hard to quit

If you were to spend the next twenty years smoking two packs of cigarettes a day you would be entering into a habit that 45 million other Americans (roughly 20% of the adult population) engage in.  During the course of the next two decades you would spend somewhere around $55,000 (based on the average price of cigarettes today and not accounting for inflation or rise in taxes) and have nothing more to show for it than yellow teeth, a smoker’s cough, and a dramatically increased risk of stroke, heart attack, cancer, and emphysema.  The 55 grand that you will have spent represents only the direct, out-of-pocket cost, and doesn’t take into account the indirect financial burden your habit will have on the healthcare system.  You will be paying higher premiums to your insurance company, and they would in turn be paying higher bills to your doctors, hospitals and pharmacies.  It costs a lot of money to treat chronic heart and lung disease.

Of course, you could prevent all this by not taking up the habit at all.  If you already smoke, you could save yourself a lot of money and misery by quitting today.  It would take determination, fortitude, and persistence.  Given the high financial toll affixed to a lifetime of cigarette use you’d think that your insurance company would jump at the chance to nip the smoking habit in the bud with a therapy that costs only a few hundred dollars.

A new medication for smoking cessation emerges, but is it worth the cost?

Chantix (varenicline) is a relatively new medication (available since August 2006) that has done more for smoking cessation that any previously developed drug.  While there’s no such thing as a magic bullet to help people kick the habit, Chantix is about as close as we’ve ever had.  In the largest study of tobacco cessation, the use of Chantix increased the participants’ chance of remaining smoke-free by three-fold when compared to other conventional methods.

The drug isn’t cheap, though.  A month’s worth of therapy runs about $120 and most patients are encouraged to stay on the drug for 90 days.  Still, $360 seems like a bargain if you compare it to the sums of money I described above.  You’d think insurance companies would fall over themselves trying to provide this for their patients, wouldn’t you?  Think again.

My experience is that the insurance providers here in Omaha almost universally deny coverage for Chantix and require that patients pay out of pocket if they want to fill the prescription.  This sort of shortsightedness bothered me for a while, but after I put some thought to it I’ve come to the conclusion that I’m glad insurance companies don’t cover it and I hope they never do.

Right now most smokers I speak to have heard of Chantix and are under the impression that it is effective.  There is a certain amount of spontaneous word-of-mouth advertising among smokers that leads them to assume a better efficacy than is perhaps realistic. As I offer them a prescription for the medication I find that each patient reacts in one of two fairly predictable ways.

  1. “Insurance doesn’t cover it?  I can’t afford $120 a month for a pill.  Forget it.”
  2. “Insurance doesn’t cover it?  No problem.  I’m already spending $120 a month on cigarettes anyway, and if I can quit I’ll save all kinds of money down the road.  Sure I’ll take the prescription.”

My belief is that the requirement for out-of-pocket payment screens out those patients who are not really serious about quitting smoking, leaving only those who will make an honest effort.  This biases the population who receives the drug and selects for people who are more likely to be successful at giving up tobacco.  In turn, the “word on the street” is that the drug is highly effective with few failures.

I’d like to keep it this way.  I’d like people to continue to believe that Chantix is going to work for them if they are serious enough about quitting that they are willing to part with their own cash.  I don’t want the public perception of Chantix watered down by a lot of treatment failures among patients who are ambivalent about quitting, but who take the drug because it is free to them.

A couple of other issues about Chantix to keep in mind:

  1. On July 2 the New York Times reported that experts at the FDA are raising concerns about Chantix.  Federal drug regulators warned that patients taking Chantix “should be watched closely for signs of serious mental illness, as reports mount of suicides among the drugs’ users.”  I don’t really know what to make of this but I plan to continue to offer Chantix to willing patients.  I’ll probably ask patients with a history of depression to clear this therapy with their primary doctors prior to initiation.
  2. A moderate number of patients on Chantix report gastrointestinal side effects.  Most of the symptoms are tolerable and worth the effort if the patient can stick with the medication.  Here’s a good resource to read up on the use of Chantix and its potential side effects.

As always, I encourage you to submit comments and questions about any post you find interesting (if you find nothing I say interesting you can comment on that, too).


Eric Van De Graaff, MD
Eric Van De Graaff, MD

Eric Van De Graaff, MD is a Heart & Vascular Specialist at CHI Health Clinic.

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