Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling.
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.
Pinget
Christophe
C
Health Technology Assessment Unit, Lausanne University Hospital, Switzerland. Christophe.Pinget@chuv.ch
Martin
Erika
E
Wasserfallen
Jean-Blaise
JB
Humair
Jean-Paul
JP
Cornuz
Jacques
J
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