title: Cost-effective primary care-based strategies to improve smoking cessation: more value for money.
abstract: BACKGROUND
  Evidence from cost-effective smoking cessation programs is scarce. This study determined the cost-effectiveness of 3 smoking cessation strategies as provided by general practitioners (GPs) in Germany.
  
  
  METHODS
  In a cluster-randomized smoking cessation trial, rates and intervention costs for 577 smoking patients of 82 GPs were followed up for 12 months. Three smoking cessation treatments were tested: (1) GP training plus GP remuneration for each abstinent patient, (2) GP training plus cost-free nicotine replacement medication and/or bupropion hydrochloride for the patient, and (3) a combination of both strategies. Smoking abstinence at 12 months was the primary outcome used to calculate incremental cost-effectiveness ratios and net monetary benefits.
  
  
  RESULTS
  Intervention 1 was not effective compared with treatment as usual (TAU). Interventions 2 and 3 each proved to be cost-effective compared separately with TAU. When applying a 95% level of certainty of cost-effectiveness against TAU, euro 9.80 or euro 6.96, respectively, had to be paid for each additional 1% of patients abstinent at 12 months (maximum willingness to pay). That means that in intervention 2, euro 92.12 per patient in the program must be invested to gain 1 additional quitter (as opposed to euro 39.10 paid per patient during the trial). In intervention 2, the cost was euro 82.82, as opposed to euro 50.04. Neither of these 2 cost-effective treatments proved to be superior to the other. The cost-effectiveness of both treatments was stable against TAU in sensitivity analyses. (The exchange rate from October 1, 2003, was used; euro1 = $1.17.)
  
  
  CONCLUSIONS
  Both treatments have a high potential to reduce smoking-related morbidity at a low cost. It is highly recommended that they be implemented as a routine service offered by GPs because in many countries, health insurance plans currently do not fund nicotine replacement therapy.
authors.affiliation: Central Institute of Mental Health, Mannheim, Germany. hans-joachim.salize@zi-mannheim.de
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Salize
authors.forename: Silke
authors.initials: S
authors.lastname: Merkel
authors.forename: Iris
authors.initials: I
authors.lastname: Reinhard
authors.forename: Dorothee
authors.initials: D
authors.lastname: Twardella
authors.forename: Karl
authors.initials: K
authors.lastname: Mann
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000191:economics / Q000627:therapeutic use; D016642:Bupropion / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005858:Germany; D006801:Humans; D008875:Middle Aged; D009538:Nicotine / Q000191:economics / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000191:economics / Q000627:therapeutic use; D010821:Physicians, Family; D011320:Primary Health Care; D012052:Reimbursement, Incentive; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine