If you try to stop smoking, should we pay for it? The cost-utility of reimbursing smoking cessation support in the Netherlands.
BACKGROUND
Smoking cessation can be encouraged by reimbursing the costs of smoking cessation support (SCS). The short-term efficiency of reimbursement has been evaluated previously. However, a thorough estimate of the long-term cost-utility is lacking.


OBJECTIVE
To evaluate long-term effects of reimbursement of SCS.


METHODS
Results from a randomized controlled trial were extrapolated to long-term outcomes in terms of health care costs and (quality adjusted) life years (QALY) gained, using the Chronic Disease Model. Our first scenario was no reimbursement. In a second scenario, the short-term cessation rates from the trial were extrapolated directly. Sensitivity analyses were based on the trial's confidence intervals. In the third scenario the additional use of SCS as found in the trial was combined with cessation rates from international meta-analyses.


RESULTS
Intervention costs per QALY gained compared to the reference scenario were approximately euro1200 extrapolating the trial effects directly, and euro4200 when combining the trial's use of SCS with the cessation rates from the literature. Taking all health care effects into account, even costs in life years gained, resulted in an estimated incremental cost-utility of euro4500 and euro7400, respectively. In both scenarios costs per QALY remained below euro16 000 in sensitivity analyses using a life-time horizon.


CONCLUSIONS
Extrapolating the higher use of SCS due to reimbursement led to more successful quitters and a gain in life years and QALYs. Accounting for overheads, administration costs and the costs of SCS, these health gains could be obtained at relatively low cost, even when including costs in life years gained. Hence, reimbursement of SCS seems to be cost-effective from a health care perspective.
Vemer
Pepijn
P
Institute for Medical Technology Assessment (iMTA), Erasmus University, Rotterdam, the Netherlands. vemer@bmg.eur.nl
Rutten-van Mölken
Maureen P M H
MP
Kaper
Janneke
J
Hoogenveen
Rudolf T
RT
van Schayck
C P
CP
Feenstra
Talitha L
TL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016642:Bupropion / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D018765:Dopamine Uptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D009426:Netherlands / Q000453:epidemiology; D009538:Nicotine / Q000191:economics / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012051:Reimbursement Mechanisms / Q000191:economics*; D012907:Smoking / Q000453:epidemiology / Q000628:therapy*; D016540:Smoking Cessation / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine