Cost‐effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD

Abstract

AimsTo assess the cost‐effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS).DesignWe used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov‐based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self‐helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life‐time costs and benefits.SettingSpain.ParticipantsAdult smoking population (16+ years).MeasurementsHealth‐care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality‐adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates.FindingsThe cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life‐time benefit–cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost‐saving: less expensive to run and generated more QALYs) from the life‐time perspective, compared with the current provision. The life‐time benefit–cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline‐standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis.ConclusionsAccording to the EQUIPTMOD modelling tool it would be cost‐effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro‐active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run.

Cost-effectiveness analysis of text messaging to support health advice for smoking cessation

“…Despite these limitations, results from the present study come along with those reported by others: 0.5 QALYs for former smokers [18], 0.069 QALYs for former smokers [56] and 0.10 QALYs for former smokers [57]. These results are also consistent with previous economic assessments showing that smoking cessation interventions using mobile phones are cost saving [18,58] and cost effective [59]. Interestingly, the program studied herein becomes more cost effective as we increase the age at initiation of the intervention, given that it increases the probability of developing a smoking-related disease and the benefit of smoking cessation is greater, as found by Guerriero et al [18] with larger savings the older the age of the study subgroup.…”

How does reimbursement status affect smoking cessation interventions? A real-life experience from the Eastern Black Sea region of Turkey

“…The efficacy of free-of-charge smoking cessation interventions has been proven in studies worldwide 11,12 . Additionally, in a recent study, proof of the cost-effectiveness and need for covering the cost smoking cessation interventions under insurance has been reported 10 .…”

“…Previous studies have proven the effectiveness of smoking cessation free-of-charge interventions 10-12 . However, the number of studies that compare the effects of free and paid interventions in real-life settings are limited, both in Turkey and worldwide 9,13 .…”

Cost–benefit analysis of funding smoking cessation before surgery

“…There is extensive evidence for the health benefits of smoking cessation. The national and international scientific literature is plagued with economic evaluations of smoking, showing the efficiency of different therapeutic options for smoking cessation, but the economic impact of quitting smoking before surgery has not been evaluated previously. In the present analysis, sources of information have been used to characterize the patient population of the CBA with representative data from across the entire nation, which minimizes the risk of lack of representation.…”

“…The combination of pharmacotherapy with medical counselling has been proven to be the most effective and safe option for helping smokers to quit. At present, none of these therapies are funded by the Spanish National Health Systems (NHS) for use in smoking cessation, even though they have been shown to be cost‐effective in Spain. So even at no cost to the NHS, this institution still benefits from their use.…”