Cost-Effectiveness of Smoking Cessation Treatment Initiated During Psychiatric Hospitalization

Abstract

Objective We examined the cost-effectiveness of smoking cessation treatment for psychiatric inpatients. Method Smokers, regardless of intention to quit, were recruited during psychiatric hospitalization and randomized to receive stage-based smoking cessation services or usual aftercare. Smoking cessation services, quality of life, and biochemically-verified abstinence from cigarettes were assessed during 18-months of follow-up. Trial findings were combined with literature on changes in smoking status and the age and gender adjusted effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness during a lifetime horizon. Results Among 223 smokers randomized between 2006 and 2008, the mean cost of smoking cessation services was $189 in the experimental treatment group and $37 in the usual care condition (p < 0.001). At the end of follow-up, 18.75% of the experimental group was abstinent from cigarettes, compared to 6.80% abstinence in the usual care group (p <0.05). The model projected that the intervention added $43 in lifetime cost and generated 0.101 additional Quality Adjusted Life Years (QALYs), an incremental cost-effectiveness ratio of $428 per QALY. Probabilistic sensitivity analysis found the experimental intervention was cost-effective against the acceptance criteria of $50,000/QALY in 99.0% of the replicates. Conclusions A cessation intervention for smokers identified in psychiatric hospitalization did not result in higher mental health care costs in the short-run and was highly cost-effective over the long-term. The stage-based intervention was a feasible and cost-effective way of addressing the high smoking prevalence in persons with serious mental illness.

Treating Tobacco Dependence at the Intersection of Diversity, Poverty, and Mental Illness: A Randomized Feasibility and Replication Trial

“…Notably, in the parent trial, the intervention, evaluated in inpatient psychiatry, was found to be highly cost-effective with an incremental cost-effectiveness ratio of $428 per quality adjusted life year. 62 …”

Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment

“…39 The cost per quit was also greater that other trials in mental health settings: including $11 496 per quit in smokers receiving treatment for depression in a psychiatric clinic 10 and $1272 per quit among smokers identified during psychiatric hospitalization. 9 The incremental cost effectiveness of $32 257 QALY was high (less efficient) than the ratios found for other smoking cessation interventions, typically not limited to smokers with mental illness. Brief advice provided during office visits had an ICER of $1240-$3620/QALY (in $2010).…”

“…[4][5][6][7] There is little information on the cost-effectiveness of these treatments. 8 Cessation interventions for smokers identified during psychiatric hospitalization 9 and for…”

Addressing Smoking in Supported Residential Facilities for People with Severe Mental Illness: Has Any Progress Been Achieved?

“…The study showed that a group framework and education tailored to the needs of SRF residents, dedicated personnel to run smoking cessation support groups and financial support to fund NRT for residents are likely needed to support success of their smoking cessation efforts. Smoking cessation group programs have been shown to be successful for people with mental illness in both community and inpatient settings [38,73,74,75]. SRF residents should not be excluded from such programs.…”