title: Cost-effectiveness analysis of smoking-cessation counseling training for physicians and pharmacists.
abstract: BACKGROUND
  Although smoking-cessation interventions typically focus directly on patients, this paper conducts an economic evaluation of a novel smoking-cessation intervention focused on training physicians and/or pharmacists to use counseling techniques that would decrease smoking rates at a reasonable cost.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of interventions that train physicians and/or pharmacists to counsel their patients on smoking-cessation techniques.
  
  
  METHODS
  Using decision-analytic modeling, we compared four strategies for smoking-cessation counseling education: training only physicians, training only pharmacists, training both physicians and pharmacists (synergy strategy), and training neither physicians nor pharmacists (i.e., no specialized training, which is the usual practice). Short-term outcomes were based on results from a clinical trial conducted in 16 communities across the Houston area; long-term outcomes were calculated from epidemiological data. Short-term outcomes were measured using the cost per quit, and long-term outcomes were measured using the cost per quality-adjusted life-year (QALY). Cost data were taken from institutional sources; both costs and QALYs were discounted at 3%.
  
  
  RESULTS
  Training both physicians and pharmacists added 0.09 QALY for 45-year-old men. However, for 45-year-old women, the discounted quality-adjusted life expectancy only increased by 0.01 QALY when comparing the synergy strategy to no intervention. The incremental cost-effectiveness ratio (ICER) of the synergy strategy with respect to the non-intervention strategy was US$868/QALY for 45-year-old men and US$8953/QALY for 45-year-old women. The results were highly sensitive to the quit rates and community size.
  
  
  CONCLUSIONS
  Synergistic educational training for physicians and pharmacists could be a cost-effective method for smoking cessation in the community.
authors: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: sbcantor@mdanderson.org.
authors: Scott B
authors: SB
authors: Cantor
authors: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Ashish A
authors: AA
authors: Deshmukh
authors: Office of Research, Texas Woman's University, Houston, TX, USA.
authors: Nancy Stancic
authors: NS
authors: Luca
authors: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Graciela M
authors: GM
authors: Nogueras-González
authors: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Tanya
authors: T
authors: Rajan
authors: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Alexander V
authors: AV
authors: Prokhorov
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000193:education*; D004496:Education, Continuing / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D010820:Physicians; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000191:economics / Q000628:therapy*; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*
keywords: Costs and cost analysis; Medical decision making; Nicotine; Smoking cessation
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