Table 6.
Summary of economic evaluations of brief counseling for smoking cessationa
| Characteristics | Ruger et al. [2008] (65) | Meenan et al. [1998] (52) | Barnett et al. [2008] (7) | Akers et al. [2007] (1) | Boyd et al. [2009] (12) |
|---|---|---|---|---|---|
| Method | |||||
| Analysis type | CEA, CUA | CEA | CEA | CEA | CEA, CUA |
| Model type | RCT | RCT | Randomized trial | Randomized trial | Observational study |
| Framing | |||||
| Setting and population | Low-income pregnant women in Boston | Hospitalized adult smokers in two acute-care hospitals in a large group-model HMO in Oregon and Washington | Smoking mental health outpatients being treated for depression | People in five northern states (Oregon, Washington, Idaho, Montana, Alaska) interested in quitting smokeless tobacco | Smokers who accessed either of the cessation services between March and May 2007 in Glasgow, Scotland |
| Intervention (comparator) | Motivational interviewing with nurse tailored to patient’s stage of readiness Brief counseling |
20-min bedside counseling session with health counselor, 12-min video, self-help materials, and one or two follow-up phone calls Usual care |
Brief contact (stop-smoking guide and referral list) Stepped smoking cessation program |
Self-help manual only Assisted self-help (manual plus videotape and two supportive phone calls from tobacco cessation counselors) |
One-to-one cessation support in pharmacies Group counseling in the community Self-quit attempt |
| Perspective | Societal | Implementing hospital | Health care payer | Societal, provider/agency | National health system |
| Time horizon | Lifetime | 1 year | 18 months | 18 months | 4 weeks, 1 year |
| Effects | |||||
| Main outcome and benefits measure | QALYs saved Life years saved |
Quit rates Life years saved |
Abstinence rates Life years gained |
Quit rates | Quit rates QALYs |
| Cost | |||||
| Cost analysis (cost components) | Direct program costs (intervention, travel, training) Neonatal intensive care costs Maternal health care costs (cardiovascular and lung diseases) |
Intervention costs (identify patients, deliver counseling, follow-up) | Costs of all smoking cessation services used by participants, including intervention and referral Mental health care costs |
Direct program costs (materials, postage, phone service, counselor and staff time) Participant and supporter’s time |
Intervention costs incurred by National Health Service (NRT, professional time, overhead, materials used) |
| Base year (costs) | 1997 | 1994 | 2003 | 2000 | 2007 |
| Source (costs) | Program records, published estimates | Project surveys, expense reports, retrospective labor estimates, HMO’s financial staff, literature estimates | Retail cost, Medicare reimbursement rates, hospital charge data, Red Book prices | Material cost in bulk, Oregon minimum wage | Resource use, National Health Service records |
| Results | |||||
| Summary results | For smoking cessation, intervention was more costly and less effective than usual care For relapse prevention, the cost-effectiveness of the intervention was $851 per life year saved and $628 per QALY saved |
Cost of intervention was $159 per smoker Incremental cost per incremental quit was $3,697 Incremental cost per incremental discounted life year saved ranged from $1,691 to $7,444 |
Smoking cessation services cost $6,204 per successful quit or $5,170 per life year gained Cessation services and mental health care cost $11,496 per successful quit or $9,580 per life year gained |
Total cost per participant from societal and provider perspective, respectively, was $0 and $0 for no treatment, $20 and $8 for manual only, and $56 and $39 for assisted self-help Incremental cost per quit from societal and provider perspective, respectively, was $691 and $264 for manual only and $1,131 and $973 for assisted self-help |
Incremental cost per 4-week quitter was $1,512 for pharmacy support and $2,158 for group support compared with self-quit cessation attempts Incremental cost per QALY gained was $8,620 for pharmacy services and $10,579 for group services |
| Characteristics | Haile et al. [2002] (40) | Thavorn et al. [2008] (75) | Dino et al. [2008] (25) | Solberg et al. [2006] (70) | Cummings et al. [1989] (24) |
|---|---|---|---|---|---|
| Method | |||||
| Analysis type | CEA | CEA | CEA | CUA | CEA |
| Model type | Cohort | Markov model | Markov transition model | Not available | Not available |
| Framing | |||||
| Setting and population | All smokers attending a noncardiac surgical preadmission clinic in Australia | Two simulated cohorts of Thai smokers ages 40, 50, and 60 years who regularly smoke 10–20 cigarettes per day | Students aged 17–25 years who smoke 5+ cigarettes per day in selected Florida schools | Hypothetical group of patients in primary care clinics in the United States | Hypothetical group of patients who are smokers and are seen during a routine office visit |
| Intervention (comparator) | Structured, interactive computerized smoking cessation program | Structured community pharmacist-based smoking cessation program (personalized and supportive advice, assessment, therapy, self-help material, follow-up visits) Usual care (assessment, brief advice and support, therapy without follow-up care) |
N-O-T teen smoking cessation program 20-min brief intervention |
Model 1: one-time counseling Model 2: model 1 + costs of smoking-attributable illness Model 3: annual counseling Model 4: model 3 + costs of smoking-attributable illness |
4 min physician counseling patients to quit smoking during routine office visit |
| Perspective | Hospital/payer | Health care system | School | Societal | Societal |
| Time horizon | 2 months, 1 year | Lifetime | Age 25 | Lifetime | Not available |
| Effects | |||||
| Main outcome and benefits measure | Quit rates Acceptability of computerized smoking cessation intervention |
Life years gained | Quit rates Life years saved |
QALYs | Quit rates Life years saved |
| Cost | |||||
| Cost analysis (cost components) | Cost of intervention (developing program, computer hardware, and software) | Intervention costs (pharmacist training, fee, medications) Direct medical costs of smoking-related diseases (COPD, lung cancer, stroke, cardiovascular disease) |
Direct intervention costs (training costs, room/board for trainer, brochures, and gifts) | Intervention costs (clinician time, medication, patient time/travel) Costs of preventable smoking-attributed illness |
Physician time spent counseling Cost of self-help materials |
| Base year (costs) | Not available (study in 1999) | 2005 | 2000 | 2000 | 1984 |
| Source (costs) | Invoice | Published studies, information centers, price index | Program/school records | Medicare reimbursement rates, wholesale costs, health care charges | Average charges physician visit, cost of materials |
| Results | |||||
| Summary results | Costs of intervention at one year was $5.80 per patient, $24.19 per smoker and $271.47 per quitter | At age 40, program resulted in cost savings to health system of $500 and $614 and 0.18 life years gained and 0.24 life years gained for men and women, respectively | Incremental cost effectiveness ratio for N-O-T program was $443 per discounted life year saved in base model ($1,029 worst-case scenario, $274 best-case scenario) | Cost-effectiveness was $1,100 and $2,266 per QALY saved for model 1 and 3, respectively Model 2 and 4 were cost-saving with a net cost of $65 and $542 saved per smoker counseled |
Brief advice cost $705–$988 per life year saved for men and $1,204–$2,058 per life year saved for women |
a
Abbreviations: BENESCO, benefits of smoking cessation on outcomes; COPD, chronic obstructive pulmonary disease; CHD, coronary heart disease; CBA, cost-benefit analysis; CEA, cost-effectiveness analysis; CUA, cost-utility analysis; HECOS, health and economic consequences of smoking; HMO, health maintenance organization; N-O-T, Not On Tobacco smoking cessation program; NRT, nicotine replacement therapy; QALYs, quality-adjusted life years; RCT, randomized-controlled trial.