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Cost Effectiveness of Smoking-Cessation Therapies

Interpretation of the Evidence and Implications for Coverage

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Summary

Smoking cessation has been called the ‘gold standard’ of healthcare cost effectiveness, producing additional years of life at costs that are well below those estimated for a wide range of healthcare interventions. However, the most effective approaches to smoking cessation are not the most cost effective.

As we move from the least resource-intensive interventions (e.g distribution of self-help cessation guides) to those that are most resource-intensive (e.g. medical treatments, including the use of nicotine replacement products), both cost and effectiveness increase, but cost increases more rapidly. Nevertheless, it must be considered that different interventions are effective for different people. Resource-intensive treatments may actually be far more cost effective for many people who may not respond to less-intensive interventions. A considered review of the evidence recommends support of all of the major forms of smoking-cessation intervention; even the most expensive are highly cost effective compared with the majority of medical practices that have been studied.

Despite their cost effectiveness, smoking-cessation services are not covered by many healthcare providers. This review concludes that such coverage is warranted, primarily because much less cost-effective secondary and tertiary care is covered, encouraging its utilisation, rather than primary prevention. However, the argument favouring coverage is not as clear-cut as might be assumed. Coverage of smoking cessation amounts to a direct subsidy for smokers who want to quit. It is not health ‘insurance’ in the theoretical meaning of the term. The distinction is important as healthcare systems contemplate future coverage of a range of behaviour-related preventive interventions.

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References

  1. Fiore MC, Bailey WC, Cohen SJ, et al. Smoking cessation. Clinical Practice Guideline no. 18. US Department of Health and Human Services, Public Health Service. AHCPR Publication No. 96-0692. Rockville (MD): Agency for Health Care Policy and Research, Apr 1996

    Google Scholar 

  2. Slama K, Karsenty S, Hirsch A. Effectiveness of minimal intervention by general practitioners with their smoking patients: a randomised, controlled trial in France. Tobacco Control 1995; 4: 162–9

    Article  Google Scholar 

  3. Oster G, Huse DM, Delea TE, et al. Cost-effectiveness of nicotine gum as an adjunct to physician’s advice against cigarette smoking. JAMA 1986; 256: 1315–8

    Article  PubMed  CAS  Google Scholar 

  4. Fiscella K, Franks P. Cost-effectiveness of the transdermal nicotine patch as an adjunct to physicians’ smoking cessation counseling. JAMA 1996; 275: 1247–51

    Article  PubMed  CAS  Google Scholar 

  5. Eddy DM. David Eddy ranks the tests. Harvard Health Letter 1992; Jul Suppl.: 10–11

    Google Scholar 

  6. Altman DG, Flora JA, Fortmann SP, et al. The cost-effectiveness of three smoking cessation programs. Am J Public Health 1987; 77: 162–5

    Article  PubMed  CAS  Google Scholar 

  7. Windsor RA, Warner KE, Cutter GR. A cost-effectiveness analysis of self-help smoking cessation methods for pregnant women. Public Health Rep 1988; 103: 83–8

    PubMed  CAS  Google Scholar 

  8. Tillgren P, Rosen M, Haglund BJ, et al. Cost-effectiveness of a tobacco ‘quit and win’ contest in Sweden. Health Policy 1993; 26: 43–53

    Article  PubMed  CAS  Google Scholar 

  9. Tillgren P, Haglund BJ, Ainetdin T, et al. Effects of different intervention strategies in the implementation of a nationwide tobacco ‘quit and win’ contest in Sweden. Tobacco Control 1995; 4: 344–50

    Article  Google Scholar 

  10. Cummings SR, Rubin SM, Oster G. The cost-effectiveness of counseling smokers to quit. JAMA 1989; 261: 75–9

    Article  PubMed  CAS  Google Scholar 

  11. Ershoff DH, Quinn VP, Mullen PD, et al. Pregnancy and medical cost outcomes of a self-help prenatal smoking cessation program in an HMO. Public Health Rep 1990; 105: 340–7

    PubMed  CAS  Google Scholar 

  12. Marks JS, Koplan JP, Hogue CJ, et al. A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women. Am J Prev Med 1990; 6: 282–9

    PubMed  CAS  Google Scholar 

  13. Windsor RA, Lowe JB, Perkins LL, et al. Health education for pregnant smokers: its behavioral impact and cost benefit. Am J Public Health 1993; 83: 201–6

    Article  PubMed  CAS  Google Scholar 

  14. Hueston WJ, Mainous AG III, Farrell JB. A cost-benefit analysis of smoking cessation programs during the first trimester of pregnancy for the prevention of low birthweight. J Fam Pract 1994; 39: 353–7

    PubMed  CAS  Google Scholar 

  15. Warner KE, Luce BR. Cost-benefit and cost-effectiveness analysis in health care: principles, practice, and potential. Ann Arbor (MI): Health Administration Press, 1982

    Google Scholar 

  16. Hodgson TA. Cigarette smoking and lifetime medical expenditures. Milbank Q 1992; 70: 81–125

    Article  PubMed  CAS  Google Scholar 

  17. Wagner EH, Curry SJ, Grothaus L, et al. The impact of smoking and quitting on health care use. Arch Intern Med 1995; 155: 1789–95

    Article  PubMed  CAS  Google Scholar 

  18. Krumholz HM, Cohen BJ, Tsevat J, et al. Cost-effectiveness of a smoking cessation program after myocardial infarction. J Am Coll Cardiol 1993; 22: 1697–702

    Article  PubMed  CAS  Google Scholar 

  19. McGhan WF, Smith MD. Pharmacoeconomic analysis of smoking-cessation interventions. Am J Health Syst Pharm 1996; 53: 45–52

    PubMed  CAS  Google Scholar 

  20. Warner KE, Smith RJ, Smith DG, Fries BE. Health and economic implications of a work-site smoking cessation program: a simulation analysis. J Occup Environ Med 1996; 38: 981–92

    Article  PubMed  CAS  Google Scholar 

  21. Elixhauser A. The costs of smoking and the cost effectiveness of smoking-cessation programs. J Public Health Policy 1990; 11: 218–37

    Article  PubMed  CAS  Google Scholar 

  22. Luce BR. Cost-effectiveness analysis: obstacles to standardisation and its use in regulating pharmaceuticals. Pharmacoeconomics 1993; 3: 1–9

    Article  PubMed  CAS  Google Scholar 

  23. Drummond MF. Cost-effectiveness guidelines for reimbursement of pharmaceuticals: is economic evaluation ready for its enhanced status? Health Econ 1992; 1: 85–92

    Article  PubMed  CAS  Google Scholar 

  24. Drummond MF. Economic evaluation of pharmaceuticals: science or marketing? Pharmacoeconomics 1992; 2: 8–13

    Article  Google Scholar 

  25. Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996

    Google Scholar 

  26. Tengs TO, Adams ME, Pliskin JS, et al. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995; 15: 369–90

    Article  PubMed  CAS  Google Scholar 

  27. Doubilet P, Weinstein MC, McNeil BJ. Use and misuse of the term ‘cost effective’ in medicine. N Engl J Med 1986; 314: 253–6

    Article  PubMed  CAS  Google Scholar 

  28. Hines D. Young smokers’ attitudes about methods for quitting smoking: barriers and benefits to using assisted methods. Addict Behav 1996; 21: 531–5

    Article  PubMed  CAS  Google Scholar 

  29. Oster G, Delea TE, Huse DM, et al. The benefits and risks of over-the-counter availability of nicotine polacrilex (‘nicotine gum’). Med Care 1996; 34: 389–402

    Article  PubMed  CAS  Google Scholar 

  30. Flay BR. Selling the smokeless society: fifty-six evaluated mass media programs and campaigns worldwide. Washington (DC): American Public Health Association, 1987

    Google Scholar 

  31. Hu TW, Keeler TE, Sung HY, et al. Impact of California anti-smoking legislation on cigarette sales, consumption, and prices. Tobacco Control 1995; 4 Suppl. 1: S34–8

    Google Scholar 

  32. Chapman S. Stop smoking clinics: a case for their abandonment. Lancet 1985; I: 918–20

    Article  Google Scholar 

  33. Danaher BG, Berkanovic E, Gerber B. Mass-media based health behavior change televised smoking cessation program. Addict Behav 1984; 9: 245–53

    Article  PubMed  CAS  Google Scholar 

  34. Orleans CT. Review of the current status of smoking cessation in the USA: progress and opportunities. Tobacco Control 1995; 4 Suppl. 2: S3–24

    Google Scholar 

  35. Hughes JR, Wadland WC, Fenwick JW, et al. Effect of cost on the self-administration and efficacy of nicotine gum: a preliminary study. Prev Med 1991; 20: 486–96

    Article  PubMed  CAS  Google Scholar 

  36. Warner KE, Chaloupka FJ, Cook PJ, et al. Criteria for determining an optimal cigarette tax: the economist’s perspective. Tobacco Control 1995; 4: 380–6

    Article  Google Scholar 

  37. U.S. Preventive Services Task Force. Guide to clinical preventive services: an assessment of the effectiveness of 169 interventions. Baltimore: Williams and Wilkins, 1989

    Google Scholar 

  38. Warner KE, Warner PA. Is an ounce of prevention worth a pound of cure? Disease prevention in health care reform. J Ambulatory Care Manage 1993; 16(4): 38–49

    PubMed  CAS  Google Scholar 

  39. Drummond MF, Stoddard GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1987

    Google Scholar 

  40. Eisenberg JM. Clinical economics: a guide to the economic analysis of clinical practices. JAMA 1989; 262: 2879–86

    Article  PubMed  CAS  Google Scholar 

  41. Haddix AC, Teutsch SM, Shaffer PA, et al., editors. Prevention effectiveness: a guide to decision analysis and economic evaluation. New York: Oxford University Press, 1996

    Google Scholar 

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Correspondence to Kenneth E. Warner.

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Warner, K.E. Cost Effectiveness of Smoking-Cessation Therapies. Pharmacoeconomics 11, 538–549 (1997). https://doi.org/10.2165/00019053-199711060-00003

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