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Addiction. 2014 Feb;109(2):314-22. doi: 10.1111/add.12404. Epub 2013 Dec 13.

Cost-effectiveness of extended cessation treatment for older smokers.

Author information

1
Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Veterans Affairs Health Economics Resource Center, Stanford University, Palo Alto, CA, USA.

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

PMID:
24329972
PMCID:
PMC4020783
DOI:
10.1111/add.12404
[Indexed for MEDLINE]
Free PMC Article

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