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. 2015 Jun:45:79-86.
doi: 10.1016/j.addbeh.2015.01.004. Epub 2015 Jan 14.

Cost-effectiveness analysis of smoking-cessation counseling training for physicians and pharmacists

Scott B Cantor  1 , Ashish A Deshmukh  2 , Nancy Stancic Luca  3 , Graciela M Nogueras-González  4 , Tanya Rajan  2 , Alexander V Prokhorov  5
Affiliations

Cost-effectiveness analysis of smoking-cessation counseling training for physicians and pharmacists

Scott B Cantor et al. Addict Behav. 2015 Jun.

Abstract

Background: Although smoking-cessation interventions typically focus directly on patients, this paper conducts an economic evaluation of a novel smoking-cessation intervention focused on training physicians and/or pharmacists to use counseling techniques that would decrease smoking rates at a reasonable cost.

Purpose: To evaluate the cost-effectiveness of interventions that train physicians and/or pharmacists to counsel their patients on smoking-cessation techniques.

Methods: Using decision-analytic modeling, we compared four strategies for smoking-cessation counseling education: training only physicians, training only pharmacists, training both physicians and pharmacists (synergy strategy), and training neither physicians nor pharmacists (i.e., no specialized training, which is the usual practice). Short-term outcomes were based on results from a clinical trial conducted in 16 communities across the Houston area; long-term outcomes were calculated from epidemiological data. Short-term outcomes were measured using the cost per quit, and long-term outcomes were measured using the cost per quality-adjusted life-year (QALY). Cost data were taken from institutional sources; both costs and QALYs were discounted at 3%.

Results: Training both physicians and pharmacists added 0.09 QALY for 45-year-old men. However, for 45-year-old women, the discounted quality-adjusted life expectancy only increased by 0.01 QALY when comparing the synergy strategy to no intervention. The incremental cost-effectiveness ratio (ICER) of the synergy strategy with respect to the non-intervention strategy was US$868/QALY for 45-year-old men and US$8953/QALY for 45-year-old women. The results were highly sensitive to the quit rates and community size.

Conclusion: Synergistic educational training for physicians and pharmacists could be a cost-effective method for smoking cessation in the community.

Keywords: Costs and cost analysis; Medical decision making; Nicotine; Smoking cessation.

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Conflict of interest statement

Conflict of Interest

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Two-way uncertainty analysis of the effect of change in quit rates on net benefits at willingness-to-pay threshold of US$50 000 of eTOEP * The dotted line represents the base case results. [Table: see text]
Figure 1
Figure 1
Two-way uncertainty analysis of the effect of change in quit rates on net benefits at willingness-to-pay threshold of US$50 000 of eTOEP * The dotted line represents the base case results. [Table: see text]
See this image and copyright information in PMC

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