Economic evaluation of a brief counselling for smoking cessation in dentistry: a case study comparing two health economic models

Abstract

ObjectivesThis study aimed to compare the cost-effectiveness estimates of a brief counselling of smoking cessation in dentistry by using two different health economic models.Design and outcome measuresIntervention effectiveness was estimated in a cluster randomised controlled trial. The number of quitters was estimated based on 7-day abstinence and on smoking reduction at follow-up. Health economic evaluation was performed using two models: (1) a population-based model employing potential impact fractions and (2) a Markov model estimating the cost-effectiveness of the intervention for the actual participants. The evaluation was performed from healthcare and societal perspectives, and health gains were expressed in quality-adjusted life-years (QALYs).SettingDental clinics in Sweden.Participants205 Swedish smokers aged 20–75 years.InterventionsA brief, structured behavioural intervention was compared with ‘usual care’.ResultsThe cost per quitter was US$552 in the intervention and US$522 in the ‘usual care’ condition. The net saving estimated with the population-based model was US$17.3 million for intervention and US$49.9 million for ‘usual care’, with health gains of 1428 QALYs and 2369 QALYs, respectively, for the whole Swedish population during 10 years. The intervention was thus dominated by ‘usual care’. The reverse was true when using the Markov model, showing net societal savings of US$71 000 for the intervention and US$57000 for ‘usual care’, with gains of 5.42 QALYs and 4.74 QALYs, respectively, for lifelong quitters.ConclusionThe comparison of intervention and ‘usual care’ derived from small-scale studies may be highly sensitive to the choice of the model used to calculate cost-effectiveness.Trial registrationThe cluster randomised trial is registered in the ISRCTN register of controlled trials with identification number ISRCTN50627997.

Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up

“…A Markov model was used to estimate health consequences and societal costs of smoking cessation, further described in a technical report 21. The model has been used in similar studies in Sweden,16 22 23 and the updated year 2015 version was used for the current analysis 21. The model simulates the societal effects of quitting smoking on three disease groups: lung cancer, COPD and cardiovascular disease, including CHD and stroke.…”

Motivational support intervention to reduce smoking and increase physical activity in smokers not ready to quit: the TARS RCT

“…• four studies 154,158,165,168 modelled smoking-related excess morbidity and/or mortality only • five studies 89,140,145,166,169 explicitly modelled one or more smoking-related morbidities, but did not model subsequent smoking behaviour or smoking-related excess morbidity or mortality • six studies 87,88,90,155,160,172 explicitly modelled one or more smoking-related morbidities and smokingrelated excess morbidity and/or mortality, but did not model subsequent smoking behaviour • nine studies 23,[104][105][106]128,152,157,159,167 modelled subsequent smoking behaviour and smoking-related excess morbidity and/or mortality, but did not explicitly model smoking-related morbidity • fourteen studies 108,[141][142][143][144][146][147][148][149][150]156,[162][163][164] modelled subsequent smoking behaviour and explicitly modelled one or more smoking-related morbidities, but did not include smoking-related excess morbidity or mortality • six studies 75,96,107,139,…”

“…Four studies used other population/cohort simulation methods, 96,139,140,172 although one of these 172 considered only lung cancer as a smoking-related disease. Two of the other models 139,140 used smoking status to estimate either smoking-related disease prevalence or incidence.…”

“…Four studies used other population/cohort simulation methods, 96,139,140,172 although one of these 172 considered only lung cancer as a smoking-related disease. Two of the other models 139,140 used smoking status to estimate either smoking-related disease prevalence or incidence. One of these 139 estimated prevalence, and also allowed for relapse and spontaneous quitting of smoking; however, it appears that relapse would result in instantaneous incidence of disease in those relapsing (if the prevalence of the disease was higher among current smokers than among former smokers) or instantaneous cure of disease in those quitting (even for incurable diseases).…”

Smoking cessation economic benefits in a human capital approach: emerging evidence in Jordan

“…In addition, a 103,970 life years were gained using the varenicline regimen, while 64,030 life years were gained using (NRT) for the whole male smoker population in Jordan who intended to quit at one moment of time. The intervention model used by Virtanen et al (2017) has estimated the cost per quitter was USD $522 using 'usual care' condition. Calculated net saving for Swedish population during 10 years, using population-based model was USD $17.3 million for intervention and USD $49.9 million in 'usual care' , with gains in quality-adjusted life-years of 1,428 and 2,369 respectively, for the whole Swedish population during 10 years.…”