Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 1:57:101828.
doi: 10.1016/j.eclinm.2023.101828. eCollection 2023 Mar.

The cost-effectiveness of tailored smoking cessation interventions for people with severe mental illness: a model-based economic evaluation

Richard Mattock  1   2 , Lesley Owen  3 , Matthew Taylor  2
Affiliations

The cost-effectiveness of tailored smoking cessation interventions for people with severe mental illness: a model-based economic evaluation

Richard Mattock et al. EClinicalMedicine. .

Abstract

Background: Tailored smoking cessation interventions, which combine behavioural and pharmaceutical support, are effective in populations with severe mental illness (SMI). We establish the cost-effectiveness of two tailored interventions in the UK: (i) a bespoke smoking cessation intervention (BSCI) versus usual care, and (ii) integrated tobacco cessation and mental health care (IC) versus standard smoking cessation clinic (SCC) referral.

Methods: This economic evaluation was conducted between January 15th 2019 and August 4th 2022. We adapted a Markov model estimating smoking status, healthcare costs and quality-adjusted life years (QALYs) across the lifetime. Intervention effectiveness and costs were obtained from a systematic review and a meta-analysis. We obtained specific parameter values for populations with SMI for mortality, risk of smoking related comorbidities, and health utility. Uncertainty was analysed in deterministic and probabilistic sensitivity analysis (PSA).

Findings: The BSCI was cost-effective versus usual care with an incremental cost-effectiveness ratio (ICER) of £3145 per QALY (incremental costs: £165; incremental QALYs: 0.05). Integrated care was cost-effective versus SCC with an ICER of £6875 per QALY (incremental costs: £292; incremental QALYs: 0.04). The BSCI and IC were cost-effective in 89% and 83% of PSA iterations respectively. The main area of uncertainty related to relapse rates.

Interpretation: Our findings suggested that the tailored interventions were cost-effective and could increase QALYs and decrease expenditure on treating smoking related morbidities if offered to people with SMI.

Funding: York Health Economics Consortium was funded by the National Institute for Health and Care Excellence to produce economic evaluations to inform public health guidelines.

Keywords: Cessation; Cost-effectiveness; Severe mental illness; Smoking; Tobacco.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Model structure. Legend: For the base model, transitions from “former smoker” to “smoker” did not occur due to application of a combined net rate for cessation and relapse. Bidirectional transitions were included in a sensitivity analysis. CHD = coronary heart disease, COPD = chronic obstructive pulmonary disease, LC = lung cancer, MI = myocardial infarction.
Fig. 2
Fig. 2
Probabilistic sensitivity analysis.
See this image and copyright information in PMC

References

    1. Edwards R. The problem of tobacco smoking. BMJ. 2004;328(7433):217–219. - PMC - PubMed
    1. Allender S., Balakrishnan R., Scarborough P., Webster P., Rayner M. The burden of smoking-related ill health in the UK. Tob control. 2009;18(4):262–267. - PubMed
    1. Ali S., Godfrey C.A., Parrott S. Public Health Research Consortium; University of York; York: 2011. Economic model of adult smoking related costs and consequences for England.
    1. Szatkowski L., McNeill A. Diverging trends in smoking behaviors according to mental health status. Nicotine Tob Res. 2015;17(3):356–360. - PMC - PubMed
    1. Lipari RN, Van Horn S. Smoking and mental illness among adults in the United States. The CBHSQ report 2017. - PubMed