title: Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment.
abstract: BACKGROUND
  We examined the cost-effectiveness of smoking cessation integrated with treatment for post-traumatic stress disorder (PTSD).
  
  
  METHODS
  Smoking veterans receiving care for PTSD (N = 943) were randomized to care integrated with smoking cessation versus referral to a smoking cessation clinic. Smoking cessation services, health care cost and utilization, quality of life, and biochemically-verified abstinence from cigarettes were assessed over 18-months of follow-up. Clinical outcomes were combined with literature on changes in smoking status and the effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness over a lifetime horizon. We discounted cost and outcomes at 3% per year and report costs in 2010 US dollars.
  
  
  RESULTS
  The mean of smoking cessation services cost was $1286 in those randomized to integrated care and $551 in those receiving standard care (P < .001). There were no significant differences in the cost of mental health services or other care. After 12 months, prolonged biochemically verified abstinence was observed in 8.9% of those randomized to integrated care and 4.5% of those randomized to standard care (P = .004). The model projected that Integrated Care added $836 in lifetime cost and generated 0.0259 quality adjusted life years (QALYs), an incremental cost-effectiveness ratio of $32 257 per QALY. It was 86.0% likely to be cost-effective compared to a threshold of $100 000/QALY.
  
  
  CONCLUSIONS
  Smoking cessation integrated with treatment for PTSD was cost-effective, within a broad confidence region, but less cost-effective than most other smoking cessation programs reported in the literature.
authors.affiliation: Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA; Treatment Research Center, Department of Psychiatry, University of California, San Francisco, CA; paul.barnett@va.gov.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Barnett
authors.affiliation: Department of Management Science and Engineering, Stanford University, Stanford, CA;
authors.forename: Abra
authors.initials: A
authors.lastname: Jeffers
authors.affiliation: Truven Health Analytics, Bethesda, MD;
authors.forename: Mark W
authors.initials: MW
authors.lastname: Smith
authors.affiliation: Veterans Affairs Cooperative Studies Program Coordinating Center, Palo Alto, CA;
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Chow
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Miles
authors.initials: M
authors.lastname: McFall
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012017:Referral and Consultation; D012907:Smoking / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D013313:Stress Disorders, Post-Traumatic / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000191:economics; D014728:Veterans; D055815:Young Adult