title: Cost-Effectiveness of a Health System-Based Smoking Cessation Program.
abstract: BACKGROUND
  Project CLIQ (Community Link to Quit) was a proactive population-outreach strategy using an electronic health records-based smoker registry and interactive voice recognition technology to connect low- to moderate-income smokers with cessation counseling, medications, and social services. A randomized trial demonstrated that the program increased cessation. We evaluated the cost-effectiveness of CLIQ from a provider organization's perspective if implemented outside the trial framework.
  
  
  METHODS
  We calculated the cost, cost per smoker, incremental cost per additional quit, and, secondarily, incremental cost per additional life year saved of the CLIQ system compared to usual care using data from a 2011-2013 randomized trial assessing the effectiveness of the CLIQ system. Sensitivity analyses considered economies of scale and initial versus ongoing costs.
  
  
  RESULTS
  Over a 20-month period (the duration of the trial) the program cost US $283 027 (95% confidence interval [CI] $209 824-$389 072) more than usual care in a population of 8544 registry-identified smokers, 707 of whom participated in the program. The cost per smoker was $33 (95% CI 28-40), incremental cost per additional quit was $4137 (95% CI $2671-$8460), and incremental cost per additional life year saved was $7301 (95% CI $4545-$15 400). One-time costs constituted 28% of costs over 20 months. Ongoing costs were dominated by personnel costs (71% of ongoing costs). Sensitivity analyses showed sharp gains in cost-effectiveness as the number of identified smokers increased because of the large initial costs.
  
  
  CONCLUSIONS
  The CLIQ system has favorable cost-effectiveness compared to other smoking cessation interventions. Cost-effectiveness will be greatest for health systems with high numbers of smokers and with the high smoker participation rates.
  
  
  CONCLUSIONS
  Health information systems capable of establishing registries of patients who are smokers are becoming more prevalent. This economic analysis illustrates the cost implications for health care systems adopting a proactive tobacco treatment outreach strategy for low- and middle-income smokers. We find that under many circumstances, the CLIQ system has a favorable cost-per-quit compared to other population-based tobacco treatment strategies. The strategy could be widely disseminable if health systems leverage economies of scale.
authors.affiliation: Mongan Institute Health Policy Center and Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.|Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Levy
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Elissa V
authors.initials: EV
authors.lastname: Klinger
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, MA.|Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.|Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Fleegler
authors.affiliation: Mongan Institute Health Policy Center and Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.|Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
authors.affiliation: Mongan Institute Health Policy Center and Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.|Department of Psychiatry, Harvard Medical School, Boston, MA.
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, MA.|Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.|Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis / Q000379:methods*; D003376:Counseling / Q000191:economics / Q000379:methods; D057286:Electronic Health Records / Q000191:economics; D005260:Female; D006078:Government Programs / Q000191:economics / Q000379:methods; D015438:Health Behavior; D006293:Health Promotion / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods*