title: Cost-effectiveness of smoking cessation to prevent age-related macular degeneration.
abstract: BACKGROUND
  Tobacco smoking is a risk factor for age-related macular degeneration, but studies of ex-smokers suggest quitting can reduce the risk.
  
  
  METHODS
  We fitted a function predicting the decline in risk of macular degeneration after quitting to data from 7 studies involving 1,488 patients. We assessed the cost-effectiveness of smoking cessation in terms of its impact on macular degeneration-related outcomes for 1,000 randomly selected U.S. smokers. We used a computer simulation model to predict the incidence of macular degeneration and blindness, the number of quality-adjusted life-years (QALYs), and direct costs (in 2004 U.S. dollars) until age 85 years. Cost-effectiveness ratios were based on the cost of the Massachusetts Tobacco Control Program. Costs and QALYs were discounted at 3% per year.
  
  
  RESULTS
  If 1,000 smokers quit, our model predicted 48 fewer cases of macular degeneration, 12 fewer cases of blindness, and a gain of 1,600 QALYs. Macular degeneration-related costs would decrease by $2.5 million if the costs of caregivers for people with vision loss were included, or by $1.1 million if caregiver costs were excluded. At a cost of $1,400 per quitter, smoking cessation was cost-saving when caregiver costs were included, and cost about $200 per QALY gained when caregiver costs were excluded. Sensitivity analyses had a negligible impact. The cost per quitter would have to exceed $77,000 for the cost per QALY for smoking cessation to reach $50,000, a threshold above which interventions are sometimes viewed as not cost-effective.
  
  
  CONCLUSIONS
  Smoking cessation is unequivocally cost-effective in terms of its impact on age-related macular degeneration outcomes alone.
authors.affiliation: Bainbridge Consultants, 222/299 Queen St, Melbourne, VIC 3000, Australia. susanhurley@bainbridgeconsultants.com
authors.forename: Susan F
authors.initials: SF
authors.lastname: Hurley
authors.forename: Jane P
authors.initials: JP
authors.lastname: Matthews
authors.forename: Robyn H
authors.initials: RH
authors.lastname: Guymer
references.citation: Med Decis Making. 2005 Jul-Aug;25(4):437-48
references.pmid: 16061896
references.citation: Arch Ophthalmol. 2001 Oct;119(10):1455-62
references.pmid: 11594944
references.citation: Am J Public Health. 2002 Jun;92(6):990-6
references.pmid: 12036794
references.citation: Ophthalmology. 2001 Apr;108(4):697-704
references.pmid: 11297486
references.citation: BMJ. 2000 Aug 5;321(7257):351-4
references.pmid: 10926595
references.citation: Tob Control. 2008 Dec;17(6):379-84
references.pmid: 18719075
references.citation: JAMA. 1996 Oct 9;276(14):1147-51
references.pmid: 8827967
references.citation: Am J Public Health. 2005 Jun;95(6):969-75
references.pmid: 15914818
references.citation: Br J Ophthalmol. 2006 Jan;90(1):75-80
references.pmid: 16361672
references.citation: Natl Vital Stat Rep. 2007 Aug 21;55(19):1-119
references.pmid: 17867520
references.citation: Arch Ophthalmol. 2000 Jan;118(1):47-51
references.pmid: 10636413
references.citation: Arch Ophthalmol. 1996 Oct;114(10):1193-6
references.pmid: 8859077
references.citation: BMJ. 2004 Apr 17;328(7445):947-9
references.pmid: 15087348
references.citation: Health Care Financ Rev. 2006 Spring;27(3):37-47
references.pmid: 17290647
references.citation: Cost Eff Resour Alloc. 2007 Jan 23;5:2
references.pmid: 17241477
references.citation: Am J Prev Med. 2001 Feb;20(2 Suppl):16-66
references.pmid: 11173215
references.citation: Cost Eff Resour Alloc. 2008 Jun 24;6:12
references.pmid: 18573218
references.citation: Pharmacoeconomics. 1997 Jun;11(6):538-49
references.pmid: 10168094
references.citation: Ophthalmology. 1997 Jan;104(1):7-21
references.pmid: 9022098
references.citation: Clin Exp Ophthalmol. 2006 Jan-Feb;34(1):6-8
references.pmid: 16451251
references.citation: Ophthalmic Epidemiol. 2004 Dec;11(5):359-67
references.pmid: 15590583
references.citation: N Engl J Med. 2006 Oct 5;355(14):1409-12
references.pmid: 17021315
references.citation: Ophthalmology. 2004 Jul;111(7):1280-7
references.pmid: 15234127
references.citation: JAMA. 1996 Oct 9;276(14):1141-6
references.pmid: 8827966
references.citation: N Engl J Med. 2006 Oct 5;355(14):1493-5
references.pmid: 17021326
references.citation: Arch Ophthalmol. 1998 Aug;116(8):1031-5
references.pmid: 9715683
references.citation: Nicotine Tob Res. 2002 Aug;4(3):311-9
references.pmid: 12215240
references.citation: Br J Ophthalmol. 2005 May;89(5):550-3
references.pmid: 15834082
references.citation: Eye (Lond). 2005 Sep;19(9):935-44
references.pmid: 16151432