Cost-effectiveness of face-to-face smoking cessation interventions: a dynamic modeling study.
OBJECTIVE
To estimate the cost-effectiveness of five face-to-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in terms of costs per quitter, costs per life-year gained, and costs per quality-adjusted life-year (QALY) gained.


METHODS
Scenarios on increased implementation of smoking cessation interventions were compared with current practice in The Netherlands. One of the five interventions was implemented for a period of 1, 10, or 75 years reaching 25% of the smokers each year. A dynamic population model, the RIVM chronic disease model, was used to project future gains in life-years and QALYs, and savings of health-care costs from a decrease in the incidence of 11 smoking-related diseases over a time horizon of 75 years. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size, and discount rates.


RESULTS
Compared with current practice, minimal GP counseling was a dominant intervention, generating both gains in life-years and QALYs and savings that were higher than intervention costs. For the other interventions, incremental costs per QALY gained ranged from about 1100 per thousand for telephone counseling to 4900 per thousand for intensive counseling with nicotine patches or gum for implementation periods of 75 years.


CONCLUSIONS
All five smoking cessation interventions were cost-effective compared with current practice, and minimal GP counseling was even cost-saving.
Feenstra
Talitha L
TL
National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
Hamberg-van Reenen
Heleen H
HH
Hoogenveen
Rudolf T
RT
Rutten-van Mölken
Maureen P M H
MP
D000293:Adolescent; D000328:Adult; D000368:Aged; D016642:Bupropion / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics*; D005194:Family Practice / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009426:Netherlands / Q000453:epidemiology; D009538:Nicotine / Q000191:economics / Q000627:therapeutic use; D010817:Physician-Patient Relations; D019057:Quality-Adjusted Life Years; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods*; D014029:Tobacco Use Disorder / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome
D016642:Bupropion; D009538:Nicotine