If you try to stop smoking, should we pay for it? The cost–utility of reimbursing smoking cessation support in the Netherlands

Authors

  • Pepijn Vemer,

    Corresponding author
    1. Institute for Medical Technology Assessment (iMTA), Erasmus University, Rotterdam, the Netherlands,
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  • Maureen P. M. H. Rutten-van Mölken,

    1. Institute for Medical Technology Assessment (iMTA), Erasmus University, Rotterdam, the Netherlands,
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  • Janneke Kaper,

    1. Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands,
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  • Rudolf T. Hoogenveen,

    1. Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands and
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  • C. P. Van Schayck,

    1. Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands,
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  • Talitha L. Feenstra

    1. Department for Prevention and Health Services Research, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands and Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands
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Pepijn Vemer, Institute for Medical Technology Assessment (iMTA), Erasmus University, PO Box 1738, 3000 DR Rotterdam, the Netherlands. E-mail: vemer@bmg.eur.nl

ABSTRACT

Background Smoking cessation can be encouraged by reimbursing the costs of smoking cessation support (SCS). The short-term efficiency of reimbursement has been evaluated previously. However, a thorough estimate of the long-term cost–utility is lacking.

Objectives To evaluate long-term effects of reimbursement of SCS.

Methods Results from a randomized controlled trial were extrapolated to long-term outcomes in terms of health care costs and (quality adjusted) life years (QALY) gained, using the Chronic Disease Model. Our first scenario was no reimbursement. In a second scenario, the short-term cessation rates from the trial were extrapolated directly. Sensitivity analyses were based on the trial's confidence intervals. In the third scenario the additional use of SCS as found in the trial was combined with cessation rates from international meta-analyses.

Results Intervention costs per QALY gained compared to the reference scenario were approximately €1200 extrapolating the trial effects directly, and €4200 when combining the trial's use of SCS with the cessation rates from the literature. Taking all health care effects into account, even costs in life years gained, resulted in an estimated incremental cost–utility of €4500 and €7400, respectively. In both scenarios costs per QALY remained below €16 000 in sensitivity analyses using a life-time horizon.

Conclusions Extrapolating the higher use of SCS due to reimbursement led to more successful quitters and a gain in life years and QALYs. Accounting for overheads, administration costs and the costs of SCS, these health gains could be obtained at relatively low cost, even when including costs in life years gained. Hence, reimbursement of SCS seems to be cost-effective from a health care perspective.

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