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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

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.
Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, London, UK.
School of Epidemiology, Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
LeLan (Ltd) Solutions, Bristol, UK.
Centre for Research on Economics an Health (CRES) Universitat Pompeu Fabra, Barcelona, Spain.
Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
Syreon Research Institute, Budapest, Hungary.
Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, the Netherlands.
Munich Center of Health Sciences, Ludwig-Maximilians-University, Munich, Germany.



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


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.




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


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.


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


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.


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.


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

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