title: Encouraging smokers to quit: the cost effectiveness of reimbursing the costs of smoking cessation treatment.
abstract: BACKGROUND
  Smoking cessation should be encouraged in order to increase life expectancy and reduce smoking-related healthcare costs. Results of a randomised trial suggested that reimbursing the costs of smoking cessation treatment (SCT) may lead to an increased use of SCT and an increased number of quitters versus no reimbursement.
  
  
  OBJECTIVE
  To assess whether reimbursement for SCT is a cost-effective intervention (from the Dutch societal perspective), we calculated the incremental costs per quitter and extrapolated this outcome to incremental costs per QALY saved versus no reimbursement.
  
  
  METHODS
  In the reimbursement trial, 1266 Dutch smokers were randomly assigned to the intervention or control group using a randomised double consent design. Reimbursement for SCT was offered to the intervention group for a period of 6 months. No reimbursement was offered to the control group. Prolonged abstinence from smoking was determined 6 months after the end of the reimbursement period. The QALYs gained from quitting were calculated until 80 years of age using data from the US. Costs (year 2002 values) were determined from the societal perspective during the reimbursement period (May-November 2002). Benefits were discounted at 4% per annum. The uncertainty of the incremental cost-effectiveness ratios was estimated using non-parametric bootstrapping.
  
  
  RESULTS
  Eighteen participants in the control group (2.8%) and 35 participants in the intervention group (5.5%) successfully quit smoking. The costs per participant were 291 euro and 322 euro, respectively. If society is willing to pay 1000 euro or 10,000 euro for an additional 12-month quitter, the probability that reimbursement for SCT would be cost effective was 50% or 95%, respectively. If society is willing to pay 18,000 euro for a QALY, the probability that reimbursement for SCT would be cost effective was 95%. However, the external validity of the extrapolation from quitters to QALYs is uncertain and several assumptions had to be made.
  
  
  CONCLUSIONS
  Reimbursement for SCT may be cost effective if Dutch society is willing to pay 10,000 euro for an additional quitter or 18,000 euro for a QALY.
authors.affiliation: Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands. janneke.kaper@hag.unimaas.nl
authors.forename: Janneke
authors.initials: J
authors.lastname: Kaper
authors.forename: Edwin J
authors.initials: EJ
authors.lastname: Wagena
authors.forename: Constant P
authors.initials: CP
authors.lastname: van Schayck
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D012051:Reimbursement Mechanisms; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome