The cost-effectiveness of a smoking cessation program for out-patients in treatment for depression


Paul G. Barnett, 795 Willow Road (152 MPD), VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. E-mail:


Aims  Smoking cessation programs are highly cost-effective. The cost-effectiveness of programs for psychiatric patients may be affected by differences in cost, efficacy, survival and quality of life. We evaluated cost-effectiveness of a program for smokers being treated for depression.

Design  A randomized trial compared brief contact to a stepped smoking cessation program in 322 cigarette smoking mental health out-patients. We determined the intervention's direct cost. Because smoking cessation may affect short-term use of mental health care, we used administrative databases and self-report to find mental health-care cost.

Findings  The 163 individuals randomized to stepped care received an average of $346 of smoking cessation services, including $221 for computer-mediated assessments of readiness to quit, and $124 for counseling, nicotine replacement therapy and bupropion. The cessation program was used by 53 participants. Total cost of smoking cessation and mental health services was $4805 in the stepped care group and $4173 in the brief-contact care group (not significantly different). After 18 months of follow-up, the stepped care group had 5.5% greater abstinence from smoking. Smoking cessation services cost $6204 per successful quit. Cessation services and mental health care cost was $11 496 per successful quit.

Conclusion  If smoking cessation yields 1.2 years additional life, the cessation services cost $5170 per life-year, and cessation services and mental health care cost $9580 per life-year. Even if quitting does not increase survival of depressed individuals as well as in other smokers, the stepped care intervention is likely to be regarded as cost-effective.