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. 2018 Jun;113 Suppl 1(Suppl Suppl 1):96-105.
doi: 10.1111/add.14093. Epub 2018 Feb 11.

Assessment of cost-effective changes to the current and potential provision of smoking cessation services: an analysis based on the EQUIPTMOD

Charlotte Anraad  1 , Kei-Long Cheung  1 , Mickaël Hiligsmann  1 , Kathryn Coyle  2 , Doug Coyle  2   3 , Lesley Owen  4 , Robert West  5 , Hein de Vries  1 , Silvia M Evers  1 , Subhash Pokhrel  2
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Assessment of cost-effective changes to the current and potential provision of smoking cessation services: an analysis based on the EQUIPTMOD

Charlotte Anraad et al. Addiction. 2018 Jun.

Abstract

Background and aims: Increasing the reach of smoking cessation services and/or including new but effective medications to the current provision may provide significant health and economic benefits; the scale of such benefits is currently unknown. The aim of this study was to estimate the cost-effectiveness from a health-care perspective of viable national level changes in smoking cessation provision in the Netherlands and England.

Methods: A Markov-based state transition model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)] was used to estimate costs and benefits [expressed in quality-adjusted life years (QALY)] of changing the current provision of smoking cessation programmes in the Netherlands and England. The changes included: (a) increasing the reach of top-level services to increase potential quitters (e.g. brief physician advice); (b) increasing the reach of behavioural support (group-based therapy and SMS text-messaging support) to increase the success rates; (c) including a new but effective medication (cytisine); and (d) all changes implemented together (combined change). The costs and QALYs generated by those changes over 2, 5, 10 years and a life-time were compared with that of the current practice in each country. Results were expressed as incremental net benefit (INB) and incremental cost-effectiveness ratio (ICER). A sequential analysis from a life-time perspective was conducted to identify the optimal change.

Results: The combined change was dominant (cost-saving) over all alternative changes and over the current practice, in both countries. The combined change would generate an incremental net benefit of €11.47 (2 years) to €56.16 (life-time) per smoker in the Netherlands and €9.96 (2 years) to €60.72 (life-time) per smoker in England. The current practice was dominated by all alternative changes.

Conclusion: Current provision of smoking cessation services in the Netherlands and England can benefit economically from the inclusion of cytisine and increasing the reach of brief physician advice, text-messaging support and group-based therapy.

Keywords: Cost-effectiveness; cytisine; economic evaluation; public health; return on investment; smoking cessation.

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Figures

Figure 1
Figure 1
Tornado diagram showing the sensitivity of incremental net benefit to cytisine's effect size values for various time horizons in England and the Netherlands
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