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Addiction. 2018 Jun;113 Suppl 1:52-64. doi: 10.1111/add.14062. Epub 2017 Dec 15.

Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD.

Author information

1
Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
2
Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, London, UK.
3
School of Epidemiology, Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
4
LeLan (Ltd) Solutions, Bristol, UK.
5
Centre for Research on Economics an Health (CRES) Universitat Pompeu Fabra, Barcelona, Spain.
6
Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
7
Syreon Research Institute, Budapest, Hungary.
8
Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, the Netherlands.
9
Munich Center of Health Sciences, Ludwig-Maximilians-University, Munich, Germany.

Abstract

AIMS:

To evaluate costs, effects and cost-effectiveness of increased reach of specific smoking cessation interventions in Germany.

DESIGN:

A Markov-based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health-care perspective (extended to include out-of-pocket payments) with life-time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates.

SETTING:

Germany.

PARTICIPANTS:

Cohort of current smoking population (18+ years) in Germany.

INTERVENTIONS:

Interventions included group-based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group-based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England.

MEASUREMENTS:

EQUIPTMOD considered reach, intervention cost, number of quitters, quality-of-life years (QALYs) gained, cost-effectiveness and return on investment.

FINDINGS:

The highest returns through reduction in smoking-related health-care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group-based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost-savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return-on-investment estimates. At a hypothetical willingness-to-pay threshold of only €5000, the probability of being cost-effective is approximately 75% for prospective scenario 1.

CONCLUSIONS:

Increasing the reach of group-based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost-effective.

KEYWORDS:

Behavioural support; EQUIPTMOD; Germany; cost-effectiveness; pharmacotherapy; policy; smoking cessation

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