Cost-effectiveness of the Danish smoking cessation interventions

Nicotine & Tobacco Research, 2013

This is an economic evaluation that meets the criteria for inclusion on NHS EED.

2006

Cost-effectiveness of interventions to reduce tobacco smoking in the Netherlands. An application of the RIVM Chronic Disease Model. Introduction Smoking is the most important single risk factor for mortality in the Netherlands and has been related to 12% of the burden of disease in Western Europe. Hence the Dutch Ministry of Health has asked to assess the cost-effectiveness of interventions to enhance smoking cessation in adults. Objective To evaluate eight interventions for smoking cessation, namely increased tobacco taxes, mass media campaigns, minimal counseling, GP support, telephone counseling, minimal counseling plus nicotine replacement therapy, intensive counseling plus nicotine replacement therapy and intensive counseling plus bupropion. Methods Costs per smoker were estimated based on bottom-up cost analysis. Combined with effectiveness data from meta-analyses and Dutch trials this gave us costs per quitter. To estimate costs per quality adjusted life year (QALY) gained, scenarios for each intervention were compared to current practice in the Netherlands. A dynamic population model, the RIVM Chronic Disease Model, was used to project future health gains and effects on health care costs. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix, and accounts for risks of relapse and incidence of smoking related diseases that depend on time since cessation. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size and discount rates. Results: A tax increase was the most efficient intervention with zero intervention costs from the health care perspective. Additional tax revenues resulting from a 20% tax increase were about 5 billion euro. Costs per smoker for a mass media campaign were relatively low (3,-), and costs per QALY were below 10.000. The effectiveness of these two population measures was uncertain. Costs per smoker for individual cessation support varied from 5 to almost 400. Although all individual interventions had proven effectiveness, the cheapest intervention had an effect that did not differ significantly from current practice cessation rates. Compared to current practice, cost-effectiveness ratios varied between about 8,800 for structured GP stop-advice (H-MIS) to 21,500 for telephone counseling for implementation periods of 5 years. Discussion and conclusions: All smoking cessation interventions were cost-effective compared to current practice. Comparison of interventions is difficult, especially for population and individual interventions, because they are often applied in combination. Taking that into account, taxes seem to provide most value for money, especially since additional tax revenues outweigh the health care costs in life years gained.

Background Many countries and regions undergo structural changes that intent to improve the effectiveness and quality of care. Until 2007, the municipalities, counties, hospitals and pharmacies shared the smoking cessation activities almost equally in Denmark. Among others, the Danish Healthcare Reform 2007 intended to add responsibility for smoking cessation intervention at county level to the municipality level. New regions should run the hospital services; exclusively. Aim To evaluate the influence of the Danish Healthcare Reform 2007 on national smoking cessation interventions. Methods From 2006 to 2010 35,087 smokers were registered in the Danish Smoking Cessation Database. The large majority underwent the 6-weeks gold standard programme for smoking cessation; a manual based patient education, motivational counseling and nicotine replacement therapy. The data collection included the setting and compliance, self-reported quittingand overall satisfaction. Results The total number...

JMIR research protocols, 2016

In Sweden, the prevalence of tobacco use is disproportionately high among socioeconomically disadvantaged groups. Previous research and clinical experience suggest that prescribed lifestyle interventions in the primary health care (PHC) setting such as Physical Activity on Prescription are effective in changing behavior. However, there is a lack of evidence for if and how such a prescription approach could be effectively transferred into the tobacco cessation context. The aim of this trial is to evaluate the effectiveness and cost-effectiveness of Tobacco Cessation on Prescription (TCP) compared to current practice for tobacco cessation targeting socioeconomically disadvantaged groups in the PHC setting in Sweden. The design is a pragmatic cluster-randomized controlled trial. The sample will consist of 928 daily tobacco users with Swedish social security numbers and permanent resident permits, recruited from 14-20 PHC centers located in socioeconomically disadvantaged areas in Stock...

Addiction (Abingdon, England), 2017

To identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context. A systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, NHS EED, and HTA. Checklist-based quality of the included studies and transferability scores were based on European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not an original research, not a model-based economic evaluation, that did not consider adult population and not from a high income country were excluded. Among the 64 economic evaluations included in the review, state-transition Markov model was the most frequently used method (n = 30/64) with Quality Adjusted Life Years (QALYs) being the most frequently used outcome measure in a ...

Addiction (Abingdon, England), 2018

To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life-time costs and benefits. Spain. Adult smoking population (16+ years). Health-care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chr...

Addiction (Abingdon, England), 2018

Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)]. Focused search of administrative and published data. A standardized checklist was developed in order to ensure consistency in methods of data collection. Adult population (15+ years) in Hungary, Netherlands, Germany, Spain and England. For passive smoking-related costs, child population (0-15 years) was also included. Costs of treating smoking-attributable diseases; productivity losses due to smoking-attributable absenteeism; and costs of implementing smoking cessation interventions. Annual costs (per case) of treating smoking attributable lung cancer were between €5074 (Hungary) and €52 ...

Clin Respir J, 2010

Introduction: Tobacco smoke is the leading preventable cause of death in the world. A total of 50% of all smokers will die from a smoking-related disease with a major impact upon quality of life and health-care costs. Tobacco-controlling policies, including smoking cessation, have increasingly been implemented across European countries. Reported effectiveness data on smoking cessation interventions are important for decision making.

Addiction (Abingdon, England), 2017

The cost-effectiveness of internet-based smoking cessation interventions is difficult to determine when they are provided as a complement to current smoking cessation services. The aim of this study was to evaluate the cost-effectiveness of such an alternate package compared with existing smoking cessation services alone (current package). A literature search was conducted to identify internet-based smoking cessation interventions in the Netherlands. A meta-analysis was then performed to determine the pooled effectiveness of a (web-based) computer-tailored intervention. The mean cost of implementing internet based interventions was calculated using available information, while intervention reach was sourced from an English study. We used EQUIPTMOD, a Markov-based state-transition model, to calculate the incremental cost-effectiveness ratios [expressed as cost per quality-adjusted life years (QALYs) gained] for different time horizons to assess the value of providing internet-based i...

International Journal of Technology Assessment in Health Care, 2004

Objectives: The cost-effectiveness of the Swedish quitline, a nation-wide, free of charge service, is assessed.Methods: The study was based on data of a sample of 1,131 callers enrolled from February 1, 2000 to November 30, 2001. Outcome was measured as cost per quitter and cost per year of life saved. Cost per quitter was based on a calculation of the total cost of the quitline divided by the number of individuals who reported abstinence after 12 months. The cost per life year saved (LYS) was calculated by the use of data from the literature on average life expectancy for smokers versus quitters, the total cost of the quitline, and the cost of pharmacological treatment.Results: The number of smokers who used the quitline and reported abstinence after 1 year was 354 (31 percent). The accumulated number of life years saved in the study population was 2,400. The cost per quitter was 1,052–1,360 USD, and the cost per life year saved was 311–401 USD. A sensitivity analysis showed that, ...