Model‐based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review

Abstract

AimsTo identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context.MethodsA systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, National Health Service (NHS) Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA). The checklist‐based quality of the included studies and transferability scores was based on the European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not original research, not a model‐based economic evaluation, that did not consider adult population and not from a high‐income country were excluded.FindingsAmong the 64 economic evaluations included in the review, the state‐transition Markov model was the most frequently used method (n = 30/64), with quality adjusted life years (QALY) being the most frequently used outcome measure in a life‐time horizon. A small number of the included studies (13 of 64) were eligible for EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97, with an average score of 0.75. The average score per section was 0.69 (range = 0.35–0.92). The relative transferability of the studies could not be established due to a limitation present in the EURONHEED method.ConclusionAll existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context.

Estimates of costs for modelling return on investment from smoking cessation interventions

“…A recently published systematic review 3 has highlighted how important transparency and sufficiency in reporting are for an economic model to be fully transferable to other settings. As noted in the systematic review, it seemed very important to assess the quality of the cost data in terms of several key attributes: intervention technologies described; monetary reference used; time dimension; cost types; costing methods; perspective; and representativeness.…”

“…However, further modelling would be required to show how to invest. In model‐based economic evaluations, the life‐time benefits of tobacco cessation interventions are compared against the total costs (in this case the economic burden/costs plus the cost of implementing services) to show which intervention(s) provide good value for money 3.…”

“…Similarly, costs of implementing tobacco cessation services are also available for different countries 7, 8, 9. These costs are often estimates based on the availability of data and resources at the time such studies are conducted, and therefore are likely to vary across studies and between contexts 3. For a ROI model that works for several countries, a standardized method to source and/or estimate costs (both economic costs of tobacco and costs of implementing interventions) is required.…”

German EstSmoke: estimating adult smoking‐related costs and consequences of smoking cessation for Germany

“…Thirdly, the impact of smoking on health‐care costs is negligible in younger ages due to the long latency periods of smoking‐related diseases . Finally, while some studies evaluating the impact of smoking cessation interventions on smoking behaviour use a starting cohort of < 35 years , almost all of them take a long‐term perspective because smoking‐attributable costs and outcomes occur mainly in later life. Therefore, for cost‐of‐illness studies (such as this study), a starting age of 35 years is appropriate for capturing the economic impact of smoking.…”

Estimates of effectiveness and reach for ‘return on investment’ modelling of smoking cessation interventions using data from England

“…‘Return on investment’ (ROI) estimates for public health interventions can inform resource allocation decisions usefully at national or regional levels 1. They are dependent upon estimates of the effectiveness and reach of the interventions being evaluated.…”