Cost-effectiveness analysis of smoking cessation interventions using cell phones in a low-income population

Abstract

Background: The prevalence of cigarette smoking is significantly higher among those living at or below the federal poverty level. Cell phone-based interventions among such populations have the potential to reduce smoking rates and be cost-effective.

Methods: We performed a cost-effectiveness analysis of three smoking cessation interventions: Standard Care (SC) (brief advice to quit, nicotine replacement therapy and self-help written materials), Enhanced Care (EC) (SC plus cell phone-delivered messaging) and Intensive Care (IC) (EC plus cell phone-delivered counselling). Quit rates were obtained from Project ACTION (Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods). We evaluated shorter-term outcomes of cost per quit and long-term outcomes using cost per quality-adjusted life year (QALY).

Results: For men, EC cost an additional $541 per quit vs SC; however, IC cost an additional $5232 per quit vs EC. For women, EC was weakly dominated by IC-IC cost an additional $1092 per quit vs SC. Similarly, for men, EC had incremental cost-effectiveness ratio (ICER) of $426 per QALY gained vs SC; however, IC resulted in ICER of $4127 per QALY gained vs EC. For women, EC was weakly dominated; the ICER of IC vs SC was $1251 per QALY gained. The ICER was below maximum acceptable willingness-to-pay threshold of $50 000 per QALY under all alternative modelling assumptions.

Discussion: Cell phone interventions for low socioeconomic groups are a cost-effective use of healthcare resources. Intensive Care was the most cost-effective strategy both for men and women.

Trial registration number: NCT00948129; Results.

Keywords: community outreach; cost and cost analysis; decision making; mobile clinic; smoking cessation; underserved populations.

Figure 1

Two-way sensitivity analysis. Figure shows the ICER, measured in dollars per quality-adjusted life year, for (A) men and (B) women, with variations on intervention costs and age of the hypothetical cohort. Results shown are ICERs based on increasing and decreasing intervention component costs by 50%. EC, Enhanced Care; IC, Intensive Care; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; SC, Standard Care.

Figure 2

Two-way sensitivity analysis for 45-year-old cohort of (A) men and (B) women. Figures show the cost-effective strategy based on a threshold of $50 000 per QALY gained as a linear combination of 6-month quit rates for the undominated strategies (determined in the base case analysis) vary. Base case values for quit rates and 95% CIs can be found in table 1. QALY, quality-adjusted life year.