title: Cost-effectiveness of intensive smoking cessation therapy among patients with small abdominal aortic aneurysms.
abstract: BACKGROUND
  Smoking cessation is one of the few available strategies to decrease the risk for expansion and rupture of small abdominal aortic aneurysms (AAAs). The cost-effectiveness of an intensive smoking cessation therapy in patients with small AAAs identified at screening was evaluated.
  
  
  METHODS
  A Markov cohort simulation model was used to compare an 8-week smoking cessation intervention with adjuvant pharmacotherapy and annual revisits vs nonintervention among 65-year-old male smokers with a small AAA identified at screening. The smoking cessation rate was tested in one-way sensitivity analyses in the intervention group (range, 22%-57%) and in the nonintervention group (range, 3%-30%). Literature data on the effect of smoking on AAA expansion and rupture was factored into the model.
  
  
  RESULTS
  The intervention was cost-effective in all tested scenarios and sensitivity analyses. The smoking cessation intervention was cost-effective due to a decreased need for AAA repair and decreased rupture rate even when disregarding the positive effects of smoking cessation on long-term survival. The incremental cost/effectiveness ratio reached the willingness-to-pay threshold value of €25,000 per life-year gained when assuming an intervention cost of > €3250 or an effect of ≤ 1% difference in long-term smoking cessation between the intervention and nonintervention groups. Smoking cessation resulted in a relative risk reduction for elective AAA repair by 9% and for rupture by 38% over 10 years of follow-up.
  
  
  CONCLUSIONS
  An adequate smoking cessation intervention in patients with small AAAs identified at screening can cost-effectively increase long-term survival and decrease the need for AAA repair.
authors.affiliation: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. kevin.mani@surgsci.uu.se
authors.forename: Kevin
authors.initials: K
authors.lastname: Mani
authors.forename: Anders
authors.initials: A
authors.lastname: Wanhainen
authors.forename: Jonas
authors.initials: J
authors.lastname: Lundkvist
authors.forename: David
authors.initials: D
authors.lastname: Lindström
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000191:economics* / Q000209:etiology / Q000628:therapy; D001019:Aortic Rupture / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D018803:Models, Economic; D011237:Predictive Value of Tests; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000191:economics*; D016540:Smoking Cessation / Q000191:economics*; D013548:Sweden; D013997:Time Factors