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Cost‐effectiveness of extended cessation treatment for older smokers
Author(s) -
Barnett Paul G.,
Wong Wynnie,
Jeffers Abra,
Munoz Ricardo,
Humfleet Gary,
Hall Sharon
Publication year - 2014
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12404
Subject(s) - medicine , nicotine replacement therapy , smoking cessation , confidence interval , abstinence , randomized controlled trial , cost effectiveness , quality adjusted life year , odds ratio , quality of life (healthcare) , physical therapy , psychiatry , risk analysis (engineering) , nursing , pathology
Aims We examined the cost‐effectiveness of extended smoking cessation treatment in older smokers. Design Participants who completed a 12‐week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy. Setting A free‐standing smoking cessation clinic. Participants A total of 402 smokers aged 50 years and older were recruited from the community. Measurements The trial measured biochemically verified abstinence from cigarettes after 2 years and the quantity of smoking cessation services utilized. Trial findings were combined with literature on changes in smoking status and the age‐ and gender‐adjusted effect of smoking on health‐care cost, mortality and quality of life over the long term in a M arkov model of cost‐effectiveness over a lifetime horizon. Findings The addition of extended cognitive behavioral therapy added $83 in smoking cessation services cost [ P = 0.012, confidence interval ( CI) = $22–212]. At the end of follow‐up, cigarette abstinence rates were 50.0% with extended cognitive behavioral therapy and 37.2% without this therapy ( P < 0.05, odds ratio 1.69, CI 1.18–2.54). The model‐based incremental cost‐effectiveness ratio was $6324 per quality‐adjusted life year ( QALY ). Probabilistic sensitivity analysis found that the additional $947 in lifetime cost of the intervention had a 95% confidence interval of −$331 to 2081; the 0.15 additional QALYs had a confidence interval of 0.035–0.280, and that the intervention was cost‐effective against a $50 000/ QALY acceptance criterion in 99.6% of the replicates. Extended nicotine replacement therapy was not cost‐effective. Conclusions Adding extended cognitive behavior therapy to standard cessation treatment was cost‐effective. Further intensification of treatment may be warranted.