title: Cost-effectiveness of extended cessation treatment for older smokers.
abstract: OBJECTIVE
  We examined the cost-effectiveness of extended smoking cessation treatment in older smokers.
  
  
  METHODS
  Participants who completed a 12-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy.
  
  
  METHODS
  A free-standing smoking cessation clinic.
  
  
  METHODS
  A total of 402 smokers aged 50 years and older were recruited from the community.
  
  
  METHODS
  The trial measured biochemically verified abstinence from cigarettes after 2 years and the quantity of smoking cessation services utilized. Trial findings were combined with literature on changes in smoking status and the age- and gender-adjusted effect of smoking on health-care cost, mortality and quality of life over the long term in a Markov model of cost-effectiveness over a lifetime horizon.
  
  
  RESULTS
  The addition of extended cognitive behavioral therapy added $83 in smoking cessation services cost [P = 0.012, confidence interval (CI) = $22-212]. At the end of follow-up, cigarette abstinence rates were 50.0% with extended cognitive behavioral therapy and 37.2% without this therapy (P < 0.05, odds ratio 1.69, CI 1.18-2.54). The model-based incremental cost-effectiveness ratio was $6324 per quality-adjusted life year (QALY). Probabilistic sensitivity analysis found that the additional $947 in lifetime cost of the intervention had a 95% confidence interval of -$331 to 2081; the 0.15 additional QALYs had a confidence interval of 0.035-0.280, and that the intervention was cost-effective against a $50 000/QALY acceptance criterion in 99.6% of the replicates. Extended nicotine replacement therapy was not cost-effective.
  
  
  CONCLUSIONS
  Adding extended cognitive behavior therapy to standard cessation treatment was cost-effective. Further intensification of treatment may be warranted.
authors: Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Veterans Affairs Health Economics Resource Center, Stanford University, Palo Alto, CA, USA.
authors: Paul G
authors: PG
authors: Barnett
authors: Wynnie
authors: W
authors: Wong
authors: Abra
authors: A
authors: Jeffers
authors: Ricardo
authors: R
authors: Munoz
authors: Gary
authors: G
authors: Humfleet
authors: Sharon
authors: S
authors: Hall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D061485:Tobacco Use Cessation Devices / Q000191:economics*; D014029:Tobacco Use Disorder / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome
keywords: Clinical trial; Markov model; cognitive behaviorial treatment; cost-effectiveness analysis; extended smoking cessation; incremental cost-effectiveness ratio; tobacco use cessation