Cost-effectiveness of extended cessation treatment for older smokers
Article first published online: 13 DEC 2013
© 2013 Society for the Study of Addiction
Volume 109, Issue 2, pages 314–322, February 2014
How to Cite
Barnett, P. G., Wong, W., Jeffers, A., Munoz, R., Humfleet, G. and Hall, S. (2014), Cost-effectiveness of extended cessation treatment for older smokers. Addiction, 109: 314–322. doi: 10.1111/add.12404
- Issue published online: 14 JAN 2014
- Article first published online: 13 DEC 2013
- Accepted manuscript online: 6 NOV 2013 03:47AM EST
- Manuscript Accepted: 24 OCT 2013
- Manuscript Revised: 21 DEC 2012
- Manuscript Received: 21 SEP 2012
- National Institute on Drug Abuse. Grant Numbers: R01 DA02538, K05 DA016752, K23 DA018691, P50 DA 09253
- Clinical trial;
- cognitive behaviorial treatment;
- cost-effectiveness analysis;
- extended smoking cessation;
- incremental cost-effectiveness ratio;
- Markov model;
- tobacco use cessation
We examined the cost-effectiveness of extended smoking cessation treatment in older smokers.
Participants who completed a 12-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy.
A free-standing smoking cessation clinic.
A total of 402 smokers aged 50 years and older were recruited from the community.
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.
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.
Adding extended cognitive behavior therapy to standard cessation treatment was cost-effective. Further intensification of treatment may be warranted.