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A national quitline service and its promotion in the mass media: modelling the health gain, health equity and cost–utility
  1. Nhung Nghiem,
  2. Christine L Cleghorn,
  3. William Leung,
  4. Nisha Nair,
  5. Frederieke S van der Deen,
  6. Tony Blakely,
  7. Nick Wilson
  1. University of Otago, Wellington, New Zealand
  1. Correspondence to Professor Nick Wilson, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health (BODE Programme), University of Otago, Wellington PO Box 7343, Wellington South, New Zealand; nick.wilson{at}otago.ac.nz

Abstract

Background Mass media campaigns and quitlines are both important distinct components of tobacco control programmes around the world. But when used as an integrated package, the effectiveness and cost-effectiveness are not well described. We therefore aimed to estimate the health gain, health equity impacts and cost–utility of the package of a national quitline service and its promotion in the mass media.

Methods We adapted an established Markov and multistate life-table macro-simulation model. The population was all New Zealand adults in 2011. Effect sizes and intervention costs were based on past New Zealand quitline data. Health system costs were from a national data set linking individual health events to costs.

Results The 1-year operation of the existing intervention package of mass media promotion and quitline service was found to be net cost saving to the health sector for all age groups, sexes and ethnic groups (saving $NZ84 million; 95%uncertainty interval 60–115 million in the base-case model). It also produced greater per capita health gains for Māori (indigenous) than non-Māori (2.2 vs 0.73 quality-adjusted life-years (QALYs) per 1000 population, respectively). The net cost saving of the intervention was maintained in all sensitivity and scenario analyses for example at a discount rate of 6% and when the intervention effect size was quartered (given the possibility of residual confounding in our estimates of smoking cessation). Running the intervention for 20 years would generate an estimated 54 000 QALYs and $NZ1.10 billion (US$0.74 billion) in cost savings.

Conclusions The package of a quitline service and its promotion in the mass media appears to be an effective means to generate health gain, address health inequalities and save health system costs. Nevertheless, the role of this intervention needs to be compared with other tobacco control and health sector interventions, some of which may be even more cost saving.

  • Economics
  • Prevention
  • Social marketing
  • Socioeconomic status
  • Cessation

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Footnotes

  • Contributors NW and TB conceived and designed the study. NW, NNg, WL and FSvdD contributed to data collection and model parameterisation. NNg built model updates. CC contributed to model validity testing. NNg generated all the model results. NW led the writing of the manuscript and all authors contributed to manuscript drafts and approved the final version.

  • Funding This work was supported by funding from the Ministry of Business, Innovation and Employment (MBIE), grant number: UOOX1406. Work on the original model was supported by a grant from the Health Research Council of New Zealand (grant 10/248).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors can be contacted for additional data and this will be provided pending agreement from the agency providing access to epidemiological and costing data (the New Zealand Ministry of Health).

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