Economic evaluation of an exercise-counselling intervention to enhance smoking cessation outcomes: The Fit2Quit trial

Leung, William; Roberts, Vaughan S; Gordon, Louisa G.; Bullen, Chris; McRobbie, Hayden; Prapavessis, Harry; Jiang, Yannan; Maddison, Ralph

doi:10.1186/s12971-017-0126-y

Cited by 5 publications

(9 citation statements)

References 27 publications

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“…[ 28 ]. Higher per capita health gains for Māori vs non-Māori were identified (iv) Pharmacy-only sales and pharmacist counseling [ 32 ] (v) Promotion of the Quitline for smoking cessation [ 33 ] (vi) Promoting smartphone apps for smoking cessation [ 34 ] (vii) Two studies [ 35 , 36 ] on permitting ready access to e-cigarettes (albeit this has now largely occurred in NZ) Not cost-effective: Exercise counseling intervention to enhance smoking cessation [ 37 ] Comment: All the cost-saving studies detailed above capture CVD-related health benefits but also the benefits of preventing 14 other tobacco-related diseases. In one tobacco tax intervention study that identified how the QALYs gained were distributed, 16.6% were from CVD prevention and the majority were from chronic respiratory disease prevention (Table S6 in Blakely et al [ 29 ]) High body-mass index (BMI) 250 QALYs gained (from the weight-loss counseling intervention applied to 21.6% of the eligible population [ 38 ]).…”

Section: Resultsmentioning

confidence: 99%

“…Of note is that Table 2 refers to a program with an individual-level component, i.e., the mass media promotion of smartphone apps for weight loss [ 39 ]. See also the comment in Table 2 on physical activity interventions for weight loss Tobacco use Exercise counseling to enhance smoking cessation NZ$ 451,000 per QALY gained ($NZ 2012) (~ US$ 328,000 in 2018) This ICER was based on the 24-week follow-up data, using a discount rate of 3.5% [ 37 ], and is probably the most realistic ICER calculated in this study. As such, this ICER would not be considered cost-effective in the NZ context.…”

Section: Resultsmentioning

confidence: 99%

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Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data

Wilson

Cleghorn

Nghiem

et al. 2023

Popul Health Metrics

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Aim We aimed to combine Global Burden of Disease (GBD) Study data and local data to identify the highest priority intervention domains for preventing cardiovascular disease (CVD) in the case study country of Aotearoa New Zealand (NZ). Methods Risk factor data for CVD in NZ were extracted from the GBD using the “GBD Results Tool.” We prioritized risk factor domains based on consideration of the size of the health burden (disability-adjusted life years [DALYs]) and then by the domain-specific interventions that delivered the highest health gains and cost-savings. Results Based on the size of the CVD health burden in DALYs, the five top prioritized risk factor domains were: high systolic blood pressure (84,800 DALYs; 5400 deaths in 2019), then dietary risk factors, then high LDL cholesterol, then high BMI and then tobacco (30,400 DALYs; 1400 deaths). But if policy-makers aimed to maximize health gain and cost-savings from specific interventions that have been studied, then they would favor the dietary risk domain (e.g., a combined fruit and vegetable subsidy plus a sugar tax produced estimated lifetime savings of 894,000 health-adjusted life years and health system cost-savings of US$11.0 billion; both 3% discount rate). Other potential considerations for prioritization included the potential for total health gain that includes non-CVD health loss and potential for achieving relatively greater per capita health gain for Māori (Indigenous) to reduce health inequities. Conclusions We were able to show how CVD risk factor domains could be systematically prioritized using a mix of GBD and country-level data. Addressing high systolic blood pressure would be the top ranked domain if policy-makers focused just on the size of the health loss. But if policy-makers wished to maximize health gain and cost-savings using evaluated interventions, dietary interventions would be prioritized, e.g., food taxes and subsidies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data

Wilson

Cleghorn

Nghiem

et al. 2023

Popul Health Metrics

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“…As it was only possible from the data to identify individuals who were non-smokers 1 year after previously describing themselves as current smokers, it was necessary to account for those smokers who attempted to quit but relapsed before being surveyed the following year. We estimate relatively high rates of quit attempts (15-25 quit attempts per 100 person-years), compared with the existing literature [104][105][106][107][108] (annual quit probabilities of around 4%). Full details are provided in Appendix 32, Smoking behaviour.…”

Section: Long-term Relapse and Spontaneous Quitsmentioning

confidence: 99%

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

Taylor

Thompson

Streeter

et al. 2023

Health Technol Assess

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Background Physical activity can support smoking cessation for smokers wanting to quit, but there have been no studies on supporting smokers wanting only to reduce. More broadly, the effect of motivational support for such smokers is unclear. Objectives The objectives were to determine if motivational support to increase physical activity and reduce smoking for smokers not wanting to immediately quit helps reduce smoking and increase abstinence and physical activity, and to determine if this intervention is cost-effective. Design This was a multicentred, two-arm, parallel-group, randomised (1 : 1) controlled superiority trial with accompanying trial-based and model-based economic evaluations, and a process evaluation. Setting and participants Participants from health and other community settings in four English cities received either the intervention (n = 457) or usual support (n = 458). Intervention The intervention consisted of up to eight face-to-face or telephone behavioural support sessions to reduce smoking and increase physical activity. Main outcome measures The main outcome measures were carbon monoxide-verified 6- and 12-month floating prolonged abstinence (primary outcome), self-reported number of cigarettes smoked per day, number of quit attempts and carbon monoxide-verified abstinence at 3 and 9 months. Furthermore, self-reported (3 and 9 months) and accelerometer-recorded (3 months) physical activity data were gathered. Process items, intervention costs and cost-effectiveness were also assessed. Results The average age of the sample was 49.8 years, and participants were predominantly from areas with socioeconomic deprivation and were moderately heavy smokers. The intervention was delivered with good fidelity. Few participants achieved carbon monoxide-verified 6-month prolonged abstinence [nine (2.0%) in the intervention group and four (0.9%) in the control group; adjusted odds ratio 2.30 (95% confidence interval 0.70 to 7.56)] or 12-month prolonged abstinence [six (1.3%) in the intervention group and one (0.2%) in the control group; adjusted odds ratio 6.33 (95% confidence interval 0.76 to 53.10)]. At 3 months, the intervention participants smoked fewer cigarettes than the control participants (21.1 vs. 26.8 per day). Intervention participants were more likely to reduce cigarettes by ≥ 50% by 3 months [18.9% vs. 10.5%; adjusted odds ratio 1.98 (95% confidence interval 1.35 to 2.90] and 9 months [14.4% vs. 10.0%; adjusted odds ratio 1.52 (95% confidence interval 1.01 to 2.29)], and reported more moderate-to-vigorous physical activity at 3 months [adjusted weekly mean difference of 81.61 minutes (95% confidence interval 28.75 to 134.47 minutes)], but not at 9 months. Increased physical activity did not mediate intervention effects on smoking. The intervention positively influenced most smoking and physical activity beliefs, with some intervention effects mediating changes in smoking and physical activity outcomes. The average intervention cost was estimated to be £239.18 per person, with an overall additional cost of £173.50 (95% confidence interval −£353.82 to £513.77) when considering intervention and health-care costs. The 1.1% absolute between-group difference in carbon monoxide-verified 6-month prolonged abstinence provided a small gain in lifetime quality-adjusted life-years (0.006), and a minimal saving in lifetime health-care costs (net saving £236). Conclusions There was no evidence that behavioural support for smoking reduction and increased physical activity led to meaningful increases in prolonged abstinence among smokers with no immediate plans to quit smoking. The intervention is not cost-effective. Limitations Prolonged abstinence rates were much lower than expected, meaning that the trial was underpowered to provide confidence that the intervention doubled prolonged abstinence. Future work Further research should explore the effects of the present intervention to support smokers who want to reduce prior to quitting, and/or extend the support available for prolonged reduction and abstinence. Trial registration This trial is registered as ISRCTN47776579. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 4. See the NIHR Journals Library website for further project information.

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“…In Leung et al (2017) and using Markov model in smokers facing increased risks of lung cancer and cardiovascular disease. The counselling intervention will only be cost-effective if adherence is in a range of 7 or more intervention calls, which then leads to the required a sufficient number of health gains for quitters.…”

Section: Literature Reviewmentioning

confidence: 99%

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

Madae’en

Istaiteyeh

Adeinat

et al. 2022

PHAR

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Background: Smoking is a major cause globally of morbidity and mortality hence life years lost, this issue manifested in 399 Million Jordanian dinars (JD)($562.3 million USD) lost yearly due to productivity lost as a consequence of smoking in Jordan1. It is no surprise that quitting smoking will reduce the loss in life years and hence productivity. In this study, using cohort simulation, we want to quantify the gains in productivity from smoking cessation aids usage for one course of smoking cessation aid varenicline or nicotine replacement therapy in comparison to physician counseling only without pharmacological therapy, in the population that intends to quit at a point of time, through campaigns nationwide, among the working-age population followed up until retirement. Methodology: We present a transparent, generic model based on accepted analytic methods that allow users to assess the present value of lifetime earnings gained (PVLE) in smokers who intend to quit. It is shown in previous studies that smoking cessation aids are cost-effective in Jordan (Madae’en et al. 2020), yet the benefit of using smoking cessation aids goes further to reduce productivity loss by reducing life years lost. Our model incorporates life-years gained from the Markov Model in Madae’en et al. (2020), simulation of Jordanian male smokers’ cohort in three scenarios of either using varenicline or nicotine replacement therapy or only physician consultation, to estimate life-years gained and hence reduction in lost productivity costs. Results: We found productivity loss was reduced in males who attempted to quit in their productive years. Using Varenicline, the researchers calculated the expected future payments (wages) count for years gained due to varenicline use for a wage average of 507 JDs ($714.5 USD) per month discounted by 8% for the rest of their productive life. As well as for the other two scenarios, the gained productivity from one course of varenicline to the male adults over 30 who intend to quit will reduce loss by more than 72 billion JDs ($101.42 billion USD) among the working-age population followed up until retirement. Conclusion: policy change must be approached to reimbursement of smoking cessation aid in the Jordanian formulary.

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Economic evaluation of an exercise-counselling intervention to enhance smoking cessation outcomes: The Fit2Quit trial

Cited by 5 publications

References 27 publications

Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data

Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data

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

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

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Economic evaluation of an exercise-counselling intervention to enhance smoking cessation outcomes: The Fit2Quit trial

Cited by 5 publications

References 27 publications

Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data

Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data

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

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

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