title: Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research.
abstract: BACKGROUND
  The Agency for Health Care Policy and Research (AHCPR) published the Smoking Cessation: Clinical Practice Guideline in 1996. Based on the results of meta-analyses and expert opinion, the guideline identifies efficacious interventions for primary care clinicians and smoking cessation specialty providers.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of clinical recommendations in AHCPR's guideline.
  
  
  METHODS
  The guideline's 15 recommended smoking cessation interventions were analyzed to determine their relative cost-effectiveness. Then, using decision probabilities, the interventions were combined into a global model of the guideline's overall cost-effectiveness.
  
  
  METHODS
  The analysis assumes that primary care clinicians screen all presenting adults for smoking status and advise and motivate all smokers to quit during the course of a routine office visit or hospitalization. Smoking cessation interventions are provided to 75% of US smokers 18 years and older who are assumed to be willing to make a quit attempt during a year's time.
  
  
  METHODS
  Three counseling interventions for primary care clinicians and 2 counseling interventions for smoking cessation specialists were modeled with and without transdermal nicotine and nicotine gum.
  
  
  METHODS
  Cost (1995 dollars) per life-year or quality-adjusted life-year (QALY) saved, at a discount of 3%.
  
  
  RESULTS
  The guideline would cost $6.3 billion to implement in its first year. As a result, society could expect to gain 1.7 million new quitters at an average cost of $3779 per quitter, $2587 per life-year saved, and $1915 for every QALY saved. Costs per QALY saved ranged from $1108 to $4542, with more intensive interventions being more cost-effective. Group intensive cessation counseling exhibited the lowest cost per QALY saved, but only 5% of smokers appear willing to undertake this type of intervention.
  
  
  CONCLUSIONS
  Compared with other preventive interventions, smoking cessation is extremely cost-effective. The more intensive the intervention, the lower the cost per QALY saved, which suggests that greater spending on interventions yields more net benefit. While all these clinically delivered interventions seem a reasonable societal investment, those involving more intensive counseling and the nicotine patch as adjuvant therapy are particularly meritorious.
authors.affiliation: Health Economics Research, Inc, Waltham, MA 02154, USA. jcromwell@her-cher.org
authors.forename: J
authors.initials: J
authors.lastname: Cromwell
authors.forename: W J
authors.initials: WJ
authors.lastname: Bartosch
authors.forename: M C
authors.initials: MC
authors.lastname: Fiore
authors.forename: V
authors.initials: V
authors.lastname: Hasselblad
authors.forename: T
authors.initials: T
authors.lastname: Baker
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003376:Counseling; D005194:Family Practice / Q000191:economics / Q000592:standards; D006801:Humans; D017059:Models, Econometric; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D000074606:Smoking Prevention; D013996:Time and Motion Studies; D014481:United States; D016270:United States Agency for Healthcare Research and Quality