Short-term effects of national smoking cessation service on smoking-related disease prevalence and healthcare costs: Experience from the National Health Insurance Service Smoking Cessation Intervention Program in Korea

INTRODUCTION: We measured the short-term clinical and economic impacts of the National Health Insurance Service (NHIS) smoking cessation program, which subsidizes the cost of pharmacotherapy and medical consultations, by comparing the changes in prevalence and healthcare costs of smoking-related diseases among cessation service users, non-users, and never smokers. METHODS: Smokers who used the cessation service from 2015 to 2017 were included (n=779315). We used claims data from the NHIS, a mandatory, single-payer insurance covering the entire Korean population, to determine the number of patients with selected diseases, their healthcare utilization, and medical costs, and compared these amounts in the one year before and after enrollment. For further comparison, we also estimated disease prevalence and medical costs in matched controls by age, sex, income, and residential area, including never smokers and smokers who never used the cessation program. RESULTS: Across all 15 selected diseases, the number of patients, days spent in the hospital, and medical costs for 1 year were consistently higher after service enrollment than before. This pattern was observed for both men and women. Notably, decreased prevalence and medical costs for pneumonia were observed among individuals aged <50 years. Healthcare utilization for any kind of disease for 1 year was 97.7%, 91.1%, and 88.8% among cessation service users, never smokers, and smokers who did not use the cessation service, respectively. The disease-specific prevalence was also highest and increased more in the cessation service users compared with the control groups. CONCLUSIONS: Cessation service users were more likely to seek healthcare. Increased healthcare utilization in the first year after cessation service use may have resulted from smoking-related conditions that led individuals to attempt smoking cessation.