Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults

Abstract

PURPOSE To help clinicians and care systems determine the priority for tobacco counseling in busy clinic schedules, we assessed the lifetime health and economic value of annually counseling youth to discourage smoking initiation and of annually counseling adults to encourage cessation. METHODSWe conducted a microsimulation analysis to estimate the health impact and cost effectiveness of both types of tobacco counseling in a US birth cohort of 4,000,000. The model used for the analysis was constructed from nationally representative data sets and structured literature reviews.RESULTS Compared with no tobacco counseling, the model predicts that annual counseling for youth would reduce the average prevalence of smoking cigarettes during adult years by 2.0 percentage points, whereas annual counseling for adults will reduce prevalence by 3.8 percentage points. Youth counseling would prevent 42,686 smoking-attributable fatalities and increase quality-adjusted life years (QALYs) by 756,601 over the lifetime of the cohort. Adult counseling would prevent 69,901 smoking-attributable fatalities and increase QALYs by 1,044,392. Youth and adult counseling would yield net savings of $225 and $580 per person, respectively. If annual tobacco counseling was provided to the cohort during both youth and adult years, then adult smoking prevalence would be 5.5 percentage points lower compared with no counseling, and there would be 105,917 fewer smoking-attributable fatalities over their lifetimes. Only one-third of the potential health and economic benefits of counseling are being realized at current counseling rates. CONCLUSIONSBrief tobacco counseling provides substantial health benefits while producing cost savings. Both youth and adult intervention are high-priority uses of limited clinician time.

Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening

“…Screening should not be viewed as an alternative to smoking cessation. In this clarification and update, the importance of smoking‐cessation counseling is more clearly stated as an important element of the process of identifying high‐risk adults who are eligible for lung cancer screening …”

Strategies to Prioritize Clinical Options in Primary Care

“…In this issue of Annals of Family Medicine, Maciosek et al present compelling evidence that childhood immunizations and efforts to prevent or stop smoking are dominant population health priorities and rank numerous other services based on potential clinical benefit and cost-effectiveness. [3][4][5] Once smoking cessation and immunizations are addressed, however, we are left wondering how to prioritize the other 439 evidence-based clinical services based on their potential benefit to an individual patient.…”

“…We anticipate that further progress may occur as risk prediction science improves, better methods of communicating results to patients in customized ways are devised, and ways of prioritizing clinical options across a broader set of clinical domains are developed. [3][4][5]13,29 To read or post commentaries in response to this article, see it online at http://www.annfammed.org/content/15/1/10. …”

Updated Priorities Among Effective Clinical Preventive Services

“…Effective community preventive services also are not included. As hospitals look for options to meet community health benefits and to help manage population health as part of accountable care organizations, they can look to resources, such as the Guide to Community Preventive Services, 45 County Health Rankings and Road Maps, 46 and the Community Health Advisor, 47 for guidance on evidence-based community preventive services. This update does not include 4 services, listed in the Supplemental Appendix that meet our conceptual scope.…”