Cost‐effectiveness of extended cessation treatment for older smokers. (13th December 2013)

• Record Type: Journal Article
• Authors: Barnett, Paul G.; Wong, Wynnie; Jeffers, Abra; Munoz, Ricardo; Humfleet, Gary; Hall, Sharon
• Is Part Of: Addiction. Volume 109:Number 2(2014:Feb.)
• Page Start: 314
• Page End: 322
• Publication Date: 2013-12-13
• Subjects: Alcoholism -- Periodicals; Drug addiction -- Periodicals; 616.86
• DOI: 10.1111/add.12404
• Languages: English
• ISSNs: 0965-2140

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="add12404-sec-0001" sec-type="section"> <title>Aims</title> <p>We examined the cost‐effectiveness of extended smoking cessation treatment in older smokers.</p> </sec> <sec id="add12404-sec-0002" sec-type="section"> <title>Design</title> <p>Participants who completed a 12‐week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy.</p> </sec> <sec id="add12404-sec-0003" sec-type="section"> <title>Setting</title> <p>A free‐standing smoking cessation clinic.</p> </sec> <sec id="add12404-sec-0004" sec-type="section"> <title>Participants</title> <p>A total of 402 smokers aged 50 years and older were recruited from the community.</p> </sec> <sec id="add12404-sec-0005" sec-type="section"> <title>Measurements</title> <p>The trial measured biochemically verified abstinence from cigarettes after 2 years and the quantity of smoking cessation services utilized. Trial findings were combined with literature on changes in smoking status and the age‐ and gender‐adjusted effect of smoking on health‐care cost, mortality and quality of life over the long term in a Markov model of cost‐effectiveness over a lifetime horizon.</p> </sec> <sec id="add12404-sec-0006" sec-type="section"> <title>Findings</title> <p>The addition of extended cognitive behavioral therapy added $83 in smoking cessation services cost [<italic>P</italic> = 0.012, confidence interval (CI) = $22–212]. At the end of follow‐up, cigarette abstinence rates were 50.0% with extended cognitive behavioral therapy and 37.2% without this therapy (<italic>P</italic> < 0.05, odds ratio 1.69, CI 1.18–2.54). The model‐based incremental cost‐effectiveness ratio was $6324 per quality‐adjusted life year (QALY). Probabilistic sensitivity analysis found that the additional $947 in lifetime cost of the intervention had a 95% confidence interval of −$331 to 2081; the 0.15 additional QALYs had a confidence interval of 0.035–0.280, and that the intervention was cost‐effective against a $50 000/QALY acceptance criterion in 99.6% of the replicates. Extended nicotine replacement therapy was not cost‐effective.</p> </sec> <sec id="add12404-sec-0007" sec-type="section"> <title>Conclusions</title> <p>Adding extended cognitive behavior therapy to standard cessation treatment was cost‐effective. Further intensification of treatment may be warranted.</p> </sec> </abstract>