The cost-effectiveness of a smoking cessation program for out-patients in treatment for depression.
OBJECTIVE
Smoking cessation programs are highly cost-effective. The cost-effectiveness of programs for psychiatric patients may be affected by differences in cost, efficacy, survival and quality of life. We evaluated cost-effectiveness of a program for smokers being treated for depression.


METHODS
A randomized trial compared brief contact to a stepped smoking cessation program in 322 cigarette smoking mental health out-patients. We determined the intervention's direct cost. Because smoking cessation may affect short-term use of mental health care, we used administrative databases and self-report to find mental health-care cost.


RESULTS
The 163 individuals randomized to stepped care received an average of $346 of smoking cessation services, including $221 for computer-mediated assessments of readiness to quit, and $124 for counseling, nicotine replacement therapy and bupropion. The cessation program was used by 53 participants. Total cost of smoking cessation and mental health services was $4805 in the stepped care group and $4173 in the brief-contact care group (not significantly different). After 18 months of follow-up, the stepped care group had 5.5% greater abstinence from smoking. Smoking cessation services cost $6204 per successful quit. Cessation services and mental health care cost was $11 496 per successful quit.


CONCLUSIONS
If smoking cessation yields 1.2 years additional life, the cessation services cost $5170 per life-year, and cessation services and mental health care cost $9580 per life-year. Even if quitting does not increase survival of depressed individuals as well as in other smokers, the stepped care intervention is likely to be regarded as cost-effective.
Barnett
Paul G
PG
Department of Psychiatry, University of California, San Francisco, CA, USA. paul.barnett@va.gov
Wong
Wynnie
W
Hall
Sharon
S
D000328:Adult; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics*; D011379:Prognosis; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods