Table 4.
Characteristics | Stapleton et al. [1999] (72) | Salize et al. [2009] (67) | Hollis et al. [2007] (45) | Fellows et al. [2007] (31) | An et al. [2006] (2) |
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Method | |||||
Analysis type | CEA | CEA | CEA | CEA | CEA |
Model type | RCT and survey | Cluster-randomized trial | Randomized trial | Pre- and postinitiative | Pre- and postinitiative |
Framing | |||||
Setting and population | Patients who smoke ≥15 cigarettes per day in 15 English counties | Patients who smoke ≥10 cigarettes per day in Germany | Oregon tobacco quitline callers who smoke ≥5 cigarettes per day | Smokers who registered for Oregon quitline service | Callers to the Minnesota QUITPLAN helpline |
Intervention (comparator) | GP brief counseling with 16-h nicotine patch treatment and booklet GP brief counseling with placebo and booklet |
GP training plus remuneration for each abstinent patient GP training plus cost-free NRT and/or bupropion hydrochloride Combination of above |
Brief, moderate, and intensive telephone counseling with or without offers of free nicotine patches | Preinitiative program Oregon tobacco quitline’s “free patch initiative” |
Quitline callers before initiative Quitline callers enrolled in multisession counseling received NRT (patch or gum) by mail |
Perspective | National Health Service | Health Insurance | State program | Program | Funding agency |
Time horizon | 12 weeks | 1 year | 1 year | 1 year | 6 months |
Effects | |||||
Main outcome and benefits measure | Life years saved | Abstinence rate | Abstinence rates | Quit rate Life years saved |
Quit rate |
Cost | |||||
Cost analysis (cost components) | Cost of treatment (counseling time, nicotine patches, patient booklets, biochemical validation of abstinence) | Intervention costs | Intervention costs | Pre- and postinitiative costs (media and intervention costs) | Program costs (counseling costs, cost of providing free NRT) |
Base year (costs) | 1998 | 2003 | 2004 | 2004 | Not available |
Source (costs) | National survey data, resource use survey | Unit costs per each element of treatment in trial | Program records of resources consumed | Quitline utilization and cost data from state, intervention providers, and patients | Estimated program costs |
Results | |||||
Summary results | Incremental cost per life year saved if practitioners could prescribe nicotine patch is $656 in patients aged <35 years, $568 in patients aged 35–44 years, $712 in patients aged 45–54 years, and $1,294 in patients aged 55–65 yrs | Compared with usual care, GP training plus drugs and GP training plus drugs and remuneration were cost-effective The cost per additional quitter was $107 per patient for GP training plus drugs and $97 per patient for GP training plus drugs and remuneration |
Compared with brief counseling with no NRT, the added costs for each additional quit was $2,467 for brief NRT, $1,912 for moderate no NRT, $2,109 for moderate NRT, $2,640 for intensive no NRT, and $2,112 for intensive NRT | Compared with preinitiative program, free patch initiative increased quitting fourfold and reduced total costs per quit by $2,688. Free patch initiative cost $86 ($22–$353) more per life year saved and $174 more per additional quit |
Average number of exsmokers per month increased from 16 to 124; cost per quit increased from $1,362 to $1,934 |
Characteristics | Fiscella et al. [1996] (32) | Cromwell et al. [1997] (23) | Wasley et al. [1997] (80) | Cornuz et al. [2006] (21) | |
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Method | |||||
Analysis type | CEA, CUA | CEA of clinical practice guidelines, CUA | CEA | CEA | |
Model type | Decision-analytic model | Decision probabilities | Meta-analysis | Markov-chain cohort simulation | |
Framing | |||||
Setting and population | Male and female smokers aged 25–69 years receiving primary care | Simulated model of U.S. smokers aged 18 and older who are willing to make a quit attempt within 1 year | Hypothetical samples of 400 established smokers who smoke ≥20 cigarettes a day | Simulated cohorts of smokers in 6 western countries (Canada, France, Spain, Switzerland, United States, and United Kingdom) | |
Intervention (comparator) | Physician-based smoking cessation counseling with nicotine patch Physician-based smoking cessation counseling alone |
Model of 5 counseling interventions for primary care physicians (minimal, brief, full) and specialists (individual intensive, group intensive) with and without transdermal nicotine and nicotine gum | Nicotine patch with brief counseling Brief physician counseling alone |
Brief cessation counseling by GP Counseling plus NRT | |
Perspective | Payer | Societal | Payer | Third-party payer | |
Time horizon | Lifetime | 1 year | Lifetime | Lifetime | |
Effects | |||||
Main outcome and benefits measure | QALYs saved | QALYs and life years saved Quit rates |
Life years saved Quit rates |
Life years saved | |
Cost | |||||
Cost analysis (cost components) | Cost of physician time, retail price of nicotine patch | Guideline costs (screening, advice, motivational sessions, interventions) | Physician time, nicotine patch | Additional physician time required, retail price of medications | |
Base year (costs) | 1995 | 1995 | 1995 | 2002–2003 | |
Source (costs) | Published average wholesale price determined by survey | Published literature, guideline reports, Medicare charges | Average retail cost, physicians’ medical fee schedule | Pharmacy prices and published price data from each country | |
Results | |||||
Summary results | The patch produced 1 additional lifetime quitter at a cost of $7,332 Incremental cost-effectiveness of the patch ranged from $4,390 to $10,943 per QALY in men and $4,955–$6,983 per QALY in women |
Guidelines yield cost of $3,779 per quitter, $2,587 per life year saved, and $1,915 per QALY saved. Costs per QALY ranged from $1,108 to $4,542 with more intensive interventions being more cost-effective | Average cost per year of life saved ranged from $965 to $1,585 for men and from $1,634 to $2,360 for women Incremental cost per year of life saved ranged from $1,796 to $2,949 for men and from $3,040 to $4,391 for women |
Cost per life year saved range: Gum: $2,230 men, $7,643 women Patch: $1,758 men, $5,131 women Spray: $1,935 men, $7,969 women Inhaler: $3,480 men, $8,700 women Bupropion: $792 men, $2,922 women |
Characteristics | Gilbert et al. [2004] (36) | Oster et al. [1986] (59) | Feenstra et al. [2005] (30) | Crealey et al. [1998] (22) | Tran et al. [2002] (76) |
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Method | |||||
Analysis type | CEA | CEA | CEA, CUA | CEA | CEA, CUA |
Model type | Markov chain cohort simulation | Meta-analysis | RIVM chronic disease | Case control | Observations |
Framing | |||||
Setting and population | Two simulated cohorts of smokers in Seychelles | Hypothetical group of smokers seen in routine office visits | Smokers in the Netherlands | Matched cases and controls in PAS model program in Northern Ireland | Patients aged 21–70 who had tried at least once to quit smoking |
Intervention (comparator) | Physician counseling alone Counseling plus one of 5 cessation therapies (gum, patch, spray, inhaler, Bupropion) |
Physician advice and counseling alone Nicotine gum and physician advice |
Minimal counseling by a GP with or without NRT Intensive counseling with NRT or bupropion Telephone counseling |
Cases received advice and motivation from pharmacist Matched controls received usual advice from pharmacists |
Pharmacist-directed smoking cessation program using 4 methods (cold turkey, patch, gum, bupropion) Self-directed quit attempt |
Perspective | Third-party payer | Payer | Societal | Payer | Payer, Societal |
Time horizon | Lifetime | Lifetime | 1, 10, or 75 years | Lifetime | 1 year, lifetime |
Effects | |||||
Main outcome and benefits measure | Life years saved | Life years saved | Quit rate Life years gained QALYs gained |
Life years saved | Quit rate Life year saved QALYs saved |
Cost | |||||
Cost analysis (cost components) | Additional physician time required Retail prices of treatment (generic medications on global market and U.S. treatment prices) |
Physicians time, gum | Intervention costs Direct health-care costs from 11 smoking-related diseases |
Direct intervention costs (PAS materials, training for pharmacists, time counseling) | Program costs (materials, pharmacist time) Retail cost of selected cessation methods |
Base year (costs) | 2002–2003 | 1984 | 2000 | 1997 | 1997 |
Source (costs) | Retail prices, wage data | Retail prices, salary rates | Estimated retail costs, standard costing manual, salary data | Estimates of program costs, salary rates | Salary data, retail costs |
Results | |||||
Summary results | Incremental cost per life year saved using U.S. prices was $3,712 for gum, $1,982 for patch, $4,597 for spray, $4,291 for inhaler, and $1,324 for bupropion | Cost per life year saved ranged from $4,113 to $6,465 in men and $6,880–$9,473 in women | Cost per QALY gained ranged from $1,109 for telephone counseling to $4,939 for intensive counseling with nicotine patches or gum | Cost per life year saved for PAS program was $337–$603 for men and $310–$1,322 for women | Incremental costs using pharmacist-directed program were $236 for cold turkey, $936 for patch, $1,232 for gum, $1,150 for bupropion |
Abbreviations: CEA, cost-effectiveness analysis; CUA, cost-utility analysis; GP, general practitioner; NRT, nicotine replacement therapy; PAS, pharmacists action on smoking; QALYs, quality-adjusted life years; RCT, randomized-controlled trial; RIVM, chronic disease model developed at the National Institute of Public Health and the Environment in the Netherlands.