title: Economic evaluation of an exercise-counselling intervention to enhance smoking cessation outcomes: The Fit2Quit trial.
abstract: BACKGROUND
  In the Fit2Quit randomised controlled trial, insufficiently-active adult cigarette smokers who contacted Quitline for support to quit smoking were randomised to usual Quitline support or to also receive ≤10 face-to-face and telephone exercise-support sessions delivered by trained exercise facilitators over the 24-week trial. This paper aims to determine the cost-effectiveness of an exercise-counselling intervention added to Quitline compared to Quitline alone in the Fit2Quit trial.
  
  
  METHODS
  Within-trial and lifetime cost-effectiveness were assessed. A published Markov model was adapted, with smokers facing increased risks of lung cancer and cardiovascular disease.
  
  
  RESULTS
  Over 24 weeks, the incremental programme cost per participant in the intervention was NZ$428 (US$289 or €226; purchasing power parity-adjusted [PPP]). The incremental cost-effectiveness ratio (ICER) for seven-day point prevalence measured at 24-week follow-up was NZ$31,733 (US$21,432 or €16,737 PPP-adjusted) per smoker abstaining. However, for the 52% who adhered to the intervention (≥7 contacts), the ICER for point prevalence was NZ$3,991 (US$2,695 or €2,105 PPP-adjusted). In this adherent subgroup, the Markov model estimated 0.057 and 0.068 discounted quality-adjusted life-year gains over the lifetime of 40-year-old males (ICER: NZ$4,431; US$2,993 or €2,337 PPP-adjusted) and females (ICER: NZ$2,909; US$1,965 or €1,534 PPP-adjusted).
  
  
  CONCLUSIONS
  The exercise-counselling intervention will only be cost-effective if adherence is a minimum of ≥7 intervention calls, which in turn leads to a sufficient number of quitters for health gains.
  
  
  BACKGROUND
  Australasian Clinical Trials Registry Number ACTRN12609000637246.
authors.affiliation: University of Otago, Wellington, PO Box 7343, New Zealand.|University of Auckland, Private Bag 92019, Auckland, New Zealand.
authors.forename: William
authors.initials: W
authors.lastname: Leung
authors.affiliation: University of Auckland, Private Bag 92019, Auckland, New Zealand.
authors.forename: Vaughan
authors.initials: V
authors.lastname: Roberts
authors.affiliation: Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Gordon
authors.affiliation: University of Auckland, Private Bag 92019, Auckland, New Zealand.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bullen
authors.affiliation: UK Centre for Tobacco Control Studies, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Hayden
authors.initials: H
authors.lastname: McRobbie
authors.affiliation: School of Kinesiology, Faculty of Medical and Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON Canada.
authors.forename: Harry
authors.initials: H
authors.lastname: Prapavessis
authors.affiliation: University of Auckland, Private Bag 92019, Auckland, New Zealand.
authors.forename: Yannan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: University of Auckland, Private Bag 92019, Auckland, New Zealand.|Centre for Physical Activity and Nutrition, Deakin University, Melbourne, VIC Australia.
authors.forename: Ralph
authors.initials: R
authors.lastname: Maddison
keywords: Economic evaluation; Exercise; Randomised controlled trial; Smoking cessation