Cost–benefit analysis of funding smoking cessation before surgery

Abstract

Background Smoking at the time of surgery is associated with postoperative complications. Quitting smoking before surgery is linked to fewer complications during the hospital stay. This work analysed whether a smoking cessation intervention before surgery is economically worthwhile when funded by the National Health System (NHS) in Spain. Methods The economic analysis considered costs and benefits of the intervention to the NHS for the year 2016. The population who would benefit comprised adult smokers who were ready to quit and for whom surgery requiring admission to hospital was planned. The intervention, a combination of medical counselling and use of a smoking cessation drug which should occur 12 weeks before surgery, considered one attempt only to quit smoking. Benefits were costs avoided by averting postoperative complications if cessation was successful. The analysis compared the net economic outcome (benefit minus cost of intervention) and the return on investment, for intervention funded by the NHS versus the current situation without funding. Results Smoking cessation increased by 21·7 per cent with funding; the rate was 32·5 per cent when funded versus 10·7 per cent without funding, producing 9611 extra quitters. The cost per averted smoker was €1753 with a benefit of €503, achieving a net economic benefit of €4·8 million per year. Given the annual cost of the intervention (€17·4 million, of which €5·6 million (32·5 per cent) represents drugs), the return on investment was 28·7 per cent annually, equivalent to €1·29 per €1 of investment. Conclusion From the perspective of the Spanish NHS, the benefit of funding smoking cessation before surgery, in terms of healthcare cost savings, appears to greatly outweigh the costs.

How can hospitals change practice to better implement smoking cessation interventions? A systematic review

“…Although brief education efforts may be easy to deliver, by themselves, they appear to be unlikely to contribute to long‐term successes in changing health professionals' practices regarding the delivery of smoking cessation. We argue that embedding smoking care successfully provides good return on investment through successful prevention, 2,99,100 and these results are especially relevant, with smoking cessation being a noted priority for health services during the COVID‐19 pandemic 101 . Consequently, investing in implementation strategies that extend beyond brief education, such as stakeholder engagement or audit and feedback, is very likely to be worthwhile.…”

Indicadores referentes à cessação do comportamento de fumar no Brasil, Pesquisa Nacional de Saúde, edições 2013 e 2019

“…Contudo, cabe destacar que o custo para tratamento das doenças causadas pelo tabagismo supera em muito aqueles para tratamento da dependência de nicotina. 28 Dados da pesquisa Vigitel, sobre a prevalência do tabaco no país, confirmam os resultados da PNS, e destacam a redução do ritmo da queda no uso do tabaco após 2016. Este comportamento pode ser efeito do enfraquecimento das medidas regulatórias que vinham sendo implementadas no Brasil ao longo dos anos, sendo necessária a retomada de estratégias mais efetivas, incluindo-se o aumento de preços do tabaco.…”

Pharmacological smoking cessation of adults aged 30–50 years with COPD

“…Adding smoking cessation medication in the national reimbursement program, or even offering the medication free of charge, could be cost-effective strategies to help patients with COPD to smoking cessation. Studies from other countries, such as Spain, the United Kingdom, and the Netherlands have showed, that funding of smoking cessation medication may increase quitting rates 49 – 51 .…”