title: The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop.
abstract: BACKGROUND
  The txt2stop trial has shown that mobile-phone-based smoking cessation support doubles biochemically validated quitting at 6 months. This study examines the cost-effectiveness of smoking cessation support delivered by mobile phone text messaging.
  
  
  METHODS
  The lifetime incremental costs and benefits of adding text-based support to current practice are estimated from a UK NHS perspective using a Markov model. The cost-effectiveness was measured in terms of cost per quitter, cost per life year gained and cost per QALY gained. As in previous studies, smokers are assumed to face a higher risk of experiencing the following five diseases: lung cancer, stroke, myocardial infarction, chronic obstructive pulmonary disease, and coronary heart disease (i.e. the main fatal or disabling, but by no means the only, adverse effects of prolonged smoking). The treatment costs and health state values associated with these diseases were identified from the literature. The analysis was based on the age and gender distribution observed in the txt2stop trial. Effectiveness and cost parameters were varied in deterministic sensitivity analyses, and a probabilistic sensitivity analysis was also performed.
  
  
  RESULTS
  The cost of text-based support per 1,000 enrolled smokers is £16,120, which, given an estimated 58 additional quitters at 6 months, equates to £278 per quitter. However, when the future NHS costs saved (as a result of reduced smoking) are included, text-based support would be cost saving. It is estimated that 18 LYs are gained per 1,000 smokers (0.3 LYs per quitter) receiving text-based support, and 29 QALYs are gained (0.5 QALYs per quitter). The deterministic sensitivity analysis indicated that changes in individual model parameters did not alter the conclusion that this is a cost-effective intervention. Similarly, the probabilistic sensitivity analysis indicated a >90 % chance that the intervention will be cost saving.
  
  
  CONCLUSIONS
  This study shows that under a wide variety of conditions, personalised smoking cessation advice and support by mobile phone message is both beneficial for health and cost saving to a health system.
authors.affiliation: Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. Carla.Guerriero@lshtm.ac.uk
authors.forename: Carla
authors.initials: C
authors.lastname: Guerriero
authors.forename: John
authors.initials: J
authors.lastname: Cairns
authors.forename: Ian
authors.initials: I
authors.lastname: Roberts
authors.forename: Anthony
authors.initials: A
authors.lastname: Rodgers
authors.forename: Robyn
authors.initials: R
authors.lastname: Whittaker
authors.forename: Caroline
authors.initials: C
authors.lastname: Free
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005382:Financing, Personal / Q000191:economics; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D017678:Sex Distribution; D016540:Smoking Cessation; D012944:Social Support; D060145:Text Messaging / Q000191:economics*; D006113:United Kingdom / Q000453:epidemiology