Cost-benefit analysis of a simulated institution-based preoperative smoking cessation intervention in patients undergoing total hip and knee arthroplasties in France.
BACKGROUND
The literature on preoperative smoking cessation indicates that smoking patients are more likely to have postoperative complications. However, the economic implications of such complications are unclear. In particular, the balance between the cost of a preoperative intervention for smoking cessation (PISC) and the benefit resulting from the potential decrease in hospitalization costs is not known.


METHODS
Only one previous study, a randomized trial involving smokers scheduled for hip or knee replacement surgery, provides sufficient data to simulate the hospital course of patients subjected or not subjected to a PISC. We used a multistate Markov-type model and official French hospital costs for 2008 to simulate this situation. The cost-benefit analysis adopted the payer's perspective.


RESULTS
The mean benefit, corresponding to the decrease in the cost of the hospital stay for a reference case patient having followed a PISC, was estimated at 313 euros, with a corresponding mean cost of the PISC estimated at 196 euros. Therefore, the PISC was associated with a cost saving of 117 euros per patient. The results were most sensitive to the cost of ICU care as a proxy for cost of smoking-related complications, and to the relative risk of complication between patients with and without a PISC.


CONCLUSIONS
Under the conditions simulated by this cost-benefit model, potential modest cost savings may accrue with implementation of an institution-based smoking cessation program through reduced total hospitalization costs that exceed the cost of the intervention.
Hejblum
Gilles
G
INSERM, U707, Service de Pneumologie et Réanimation, Paris, France. Electronic address: gilles.hejblum@inserm.fr.
Atsou
Kokuvi
K
UPMC Univ Paris 06 UMR S 707, Service de Pneumologie et Réanimation, Paris, France.
Dautzenberg
Bertrand
B
AP-HP, Groupe Hospitalier Pitié-Salpêetrière, Service de Pneumologie et Réanimation, Paris, France.
Chouaid
Christos
C
AP-HP, Hêopital Saint Antoine, Service de Pneumologie, Paris, France.
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000191:economics*; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D005602:France; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008390:Markov Chains; D016544:Patient Simulation; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods*