Cost-effectiveness of extended cessation treatment for older smokers

Abstract

Aims: We examined the cost-effectiveness of extended smoking cessation treatment in older smokers.

Design: Participants who completed a 12-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy.

Setting: A free-standing smoking cessation clinic.

Participants: A total of 402 smokers aged 50 years and older were recruited from the community.

Measurements: 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.

Findings: The addition of extended cognitive behavioral therapy added $83 in smoking cessation services cost [P = 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 (P < 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.

Conclusions: Adding extended cognitive behavior therapy to standard cessation treatment was cost-effective. Further intensification of treatment may be warranted.

Trial registration: ClinicalTrials.gov NCT00086385.

Keywords: Clinical trial; Markov model; cognitive behaviorial treatment; cost-effectiveness analysis; extended smoking cessation; incremental cost-effectiveness ratio; tobacco use cessation.