title: Funding a smoking cessation program for Crohn's disease: an economic evaluation.
abstract: OBJECTIVE
  Patients with Crohn's disease (CD) who smoke are at a higher risk of flaring and requiring surgery. Cost-effectiveness studies of funding smoking cessation programs are lacking. Thus, we performed a cost-utility analysis of funding smoking cessation programs for CD.
  
  
  METHODS
  A cost-utility analysis was performed comparing five smoking cessation strategies: No Program, Counseling, Nicotine Replacement Therapy (NRT), NRT+Counseling, and Varenicline. The time horizon for the Markov model was 5 years. The health states included medical remission (azathioprine or antitumor necrosis factor (anti-TNF), dose escalation of an anti-TNF, second anti-TNF, surgery, and death. Probabilities were taken from peer-reviewed literature, and costs (CAN$) for surgery, medications, and smoking cessation programs were estimated locally. The primary outcome was the cost per quality-adjusted life year (QALY) gained associated with each smoking cessation strategy. Threshold, three-way sensitivity, probabilistic sensitivity analysis (PSA), and budget impact analysis (BIA) were carried out.
  
  
  RESULTS
  All strategies dominated No Program. Strategies from most to least cost effective were as follows: Varenicline (cost: $55,614, QALY: 3.70), NRT+Counseling (cost: $58,878, QALY: 3.69), NRT (cost: $59,540, QALY: 3.69), Counseling (cost: $61,029, QALY: 3.68), and No Program (cost: $63,601, QALY: 3.67). Three-way sensitivity analysis demonstrated that No Program was only more cost effective when every strategy's cost exceeded approximately 10 times their estimated costs. The PSA showed that No Program was the most cost-effective <1% of the time. The BIA showed that any strategy saved the health-care system money over No Program.
  
  
  CONCLUSIONS
  Health-care systems should consider funding smoking cessation programs for CD, as they improve health outcomes and reduce costs.
authors.affiliation: 1] Department of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Coward
authors.affiliation: 1] Department of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Heitman
authors.affiliation: Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Clement
authors.affiliation: 1] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada [2] Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Negron
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: 1] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada [2] Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Herman W
authors.initials: HW
authors.lastname: Barkema
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Seow
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Yvette P Y
authors.initials: YP
authors.lastname: Leung
authors.affiliation: 1] Department of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D001552:Benzazepines / Q000191:economics / Q000627:therapeutic use; D002170:Canada; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000191:economics / Q000523:psychology / Q000628:therapy; D037001:Directive Counseling / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D015233:Models, Statistical; D018722:Nicotinic Agonists / Q000191:economics / Q000627:therapeutic use; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D011810:Quinoxalines / Q000191:economics / Q000627:therapeutic use; D012907:Smoking / Q000503:physiopathology / Q000628:therapy; D016540:Smoking Cessation / Q000191:economics / Q000379:methods; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D007166:Immunosuppressive Agents; D018722:Nicotinic Agonists; D011810:Quinoxalines; D014409:Tumor Necrosis Factor-alpha; D001379:Azathioprine; D000068580:Varenicline