title: Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling.
abstract: BACKGROUND
  Physician training in smoking cessation counseling has been shown to be effective as a means to increase quit success. We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme. Its effectiveness was previously demonstrated in a cluster randomized, control trial performed in two Swiss university outpatients clinics, in which residents were randomized to receive training in smoking interventions or a control educational intervention.
  
  
  METHODS
  We used a Markov simulation model for effectiveness analysis. This model incorporates the intervention efficacy, the natural quit rate, and the lifetime probability of relapse after 1-year abstinence. We used previously published results in addition to hospital service and outpatient clinic cost data. The time horizon was 1 year, and we opted for a third-party payer perspective.
  
  
  RESULTS
  The incremental cost of the intervention amounted to US$2.58 per consultation by a smoker, translating into a cost per life-year saved of US$25.4 for men and 35.2 for women. One-way sensitivity analyses yielded a range of US$4.0-107.1 in men and US$9.7-148.6 in women. Variations in the quit rate of the control intervention, the length of training effectiveness, and the discount rate yielded moderately large effects on the outcome. Variations in the natural cessation rate, the lifetime probability of relapse, the cost of physician training, the counseling time, the cost per hour of physician time, and the cost of the booklets had little effect on the cost-effectiveness ratio.
  
  
  CONCLUSIONS
  Training residents in smoking cessation counseling is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions.
authors.affiliation: Health Technology Assessment Unit, Lausanne University Hospital, Switzerland. Christophe.Pinget@chuv.ch
authors.forename: Christophe
authors.initials: C
authors.lastname: Pinget
authors.forename: Erika
authors.initials: E
authors.lastname: Martin
authors.forename: Jean-Blaise
authors.initials: JB
authors.lastname: Wasserfallen
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Humair
authors.forename: Jacques
authors.initials: J
authors.lastname: Cornuz
mesh_terms: D000328:Adult; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D037001:Directive Counseling / Q000191:economics*; D004503:Education, Medical, Graduate / Q000191:economics*; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D010820:Physicians / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012017:Referral and Consultation / Q000191:economics; D016540:Smoking Cessation / Q000191:economics*; D013557:Switzerland