Background The prevalence of cigarette smoking is significantly higher among those living at or below the federal poverty level. Cell phone-based interventions among such populations have the potential to reduce smoking rates and be cost-effective.
Methods We performed a cost-effectiveness analysis of three smoking cessation interventions: Standard Care (SC) (brief advice to quit, nicotine replacement therapy and self-help written materials), Enhanced Care (EC) (SC plus cell phone-delivered messaging) and Intensive Care (IC) (EC plus cell phone-delivered counselling). Quit rates were obtained from Project ACTION (Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods). We evaluated shorter-term outcomes of cost per quit and long-term outcomes using cost per quality-adjusted life year (QALY).
Results For men, EC cost an additional $541 per quit vs SC; however, IC cost an additional $5232 per quit vs EC. For women, EC was weakly dominated by IC—IC cost an additional $1092 per quit vs SC. Similarly, for men, EC had incremental cost-effectiveness ratio (ICER) of $426 per QALY gained vs SC; however, IC resulted in ICER of $4127 per QALY gained vs EC. For women, EC was weakly dominated; the ICER of IC vs SC was $1251 per QALY gained. The ICER was below maximum acceptable willingness-to-pay threshold of $50 000 per QALY under all alternative modelling assumptions.
Discussion Cell phone interventions for low socioeconomic groups are a cost-effective use of healthcare resources. Intensive Care was the most cost-effective strategy both for men and women.
Trial registration number NCT00948129; Results.
- smoking cessation
- cost and cost analysis
- decision making
- underserved populations
- community outreach
- mobile clinic
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Contributors SBC had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: SBC. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: ATD, AAD, SBC. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: ATD, AAD, SGF, SBC. Obtained funding: DJV, AVP. Administrative, technical or material support: all authors. Study supervision: DJV, SBC.
Funding Financial support for this study was provided in part by grant CA141628 from the National Cancer Institute.
Competing interests None declared.
Patient consent Not required.
Ethics approval The University of Texas MD Anderson Cancer Center Institutional Review Board (IRB4).
Provenance and peer review Not commissioned; externally peer reviewed.