Cost-effective primary care-based strategies to improve smoking cessation: more value for money.
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.
Salize
Hans Joachim
HJ
Central Institute of Mental Health, Mannheim, Germany. hans-joachim.salize@zi-mannheim.de
Merkel
Silke
S
Reinhard
Iris
I
Twardella
Dorothee
D
Mann
Karl
K
Brenner
Hermann
H
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*
D018687:Antidepressive Agents, Second-Generation; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine