Smoking Cessation: A Comparison of Two Model Structures

Pennington, Becky; Filby, Alex; Owen, Lesley; Taylor, Matthew

doi:10.1007/s40273-018-0657-y

Cited by 11 publications

(15 citation statements)

References 36 publications

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“…The model does not include the health problems related to passive smoking, such as risk of CHDs in offspring28 and increase in risk for breast cancer 29. That makes our estimations more conservative with respect to cost savings and QALYs, although these three diseases groups do account for over 80% of morbidity (and mortality) associated with smoking and are frequently used in similar studies 15 30. Another limitation is that the model does not include the relapse rate among the quitters.…”

Section: Discussionmentioning

confidence: 99%

“…One of the reasons of the quality issues is that all those studies are based on short-term follow-up (from 6 months to 1 year), and they have no possibilities to validate the sustainability of short-term effectiveness in real life; thus, they cannot confirm the reported cost-effectiveness results and policy recommendations. Moreover, the long-term assumption, such as relapse rate, might change the results of the smoking cessation cost-effectiveness 15…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Feldman

Helgason

Johansson³

et al. 2019

BMJ Open

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ObjectivesThe aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up.Design and outcome measuresIntervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5–8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (€) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio.SettingThe study was conducted in dental clinics in Sweden.Participants294 smokers aged 19–71 years were included in the study.InterventionsBehaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT).ResultsThe more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5–8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to €918 and €3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden.ConclusionCEA favours the more costly HIT if decision makers are willing to spend at least €4000/QALY for tobacco cessation treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Feldman

Helgason

Johansson³

et al. 2019

BMJ Open

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“…The economic model simulates the course of TDT disease, treatment and outcomes. It was implemented in Microsoft Excel® using the discretely integrated condition event (DICE) platform [21][22][23]. Design, implementation, and validation followed modeling good research practices recommendations from the International Society for Pharmacoeconomics and Outcomes Research and Society for Medical Decision Making [24].…”

Section: Model Overviewmentioning

confidence: 99%

Economic evaluation of betibeglogene autotemcel (Beti-cel) gene addition therapy in transfusion-dependent β-thalassemia

Kansal

Reifsnider

Brand

et al. 2021

Journal of Market Access & Health Policy

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Background: Standard of care (SoC) for transfusion-dependent β-thalassemia (TDT) requires lifelong, regular blood transfusions as well as chelation to reduce iron accumulation. Objective: This study investigates the cost-effectiveness of betibeglogene autotemcel ('beti-cel'; LentiGlobin for β-thalassemia) one-time, gene addition therapy compared to lifelong SoC for TDT. Study design: Microsimulation model simulated the lifetime course of TDT based on a causal sequence in which transfusion requirements determine tissue iron levels, which in turn determine risk of iron overload complications that increase mortality. Clinical trial data informed beti-cel clinical parameters; effects of SoC on iron levels came from real-world studies; iron overload complication rates and mortality were based on published literature. Setting: USA; commercial payer perspective Participants: TDT patients age 2-50 Interventions: Beti-cel is compared to SoC. Main outcome measure: Incremental cost-effectiveness ratio (ICER) utilizing quality-adjusted lifeyears (QALYs) Results: The model predicts beti-cel adds 3.8 discounted life years (LYs) or 6.9 QALYs versus SoC. Discounted lifetime costs were $2.28 M for beti-cel ($572,107 if excluding beti-cel cost) and $2.04 M for SoC, with a resulting ICER of $34,833 per QALY gained. Conclusion:Beti-cel is cost-effective for TDT patients compared to SoC. This is due to longer survival and cost offset of lifelong SoC.

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“…Data provided by SPS added to the robustness of the results and allowed evaluation of a wider range of outcomes. Other strengths of the analysis include the use of a Markov model structure, as in other recent economic evaluations of smoking cessation, 65,[84][85][86] a conservative approach to parameter estimation, and SAs where evidence was scarce. This health economic analysis thus provides a foundation for further research and demonstrates consistent results for an initial benchmark in cost-effectiveness and economic evidence for jurisdictions contemplating a smoke-free prison policy.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Process and impact of implementing a smoke-free policy in prisons in Scotland: TIPs mixed-methods study

et al. 2022

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Background Prisons had partial exemption from the UK’s 2006/7 smoking bans in enclosed public spaces. They became one of the few workplaces with continuing exposure to second-hand smoke, given the high levels of smoking among people in custody. Despite the introduction of smoke-free prisons elsewhere, evaluations of such ‘bans’ have been very limited to date. Objective The objective was to provide evidence on the process and impact of implementing a smoke-free policy across a national prison service. Design The Tobacco in Prisons study was a three-phase, multimethod study exploring the periods before policy formulation (phase 1: pre announcement), during preparation for implementation (phase 2: preparatory) and after implementation (phase 3: post implementation). Setting The study was set in Scotland’s prisons. Participants Participants were people in custody, prison staff and providers/users of prison smoking cessation services. Intervention Comprehensive smoke-free prison rules were implemented across all of Scotland’s prisons in November 2018. Main outcome measures The main outcome measures were second-hand smoke levels, health outcomes and perspectives/experiences, including facilitators of successful transitions to smoke-free prisons. Data sources The study utilised cross-sectional surveys of staff (total, n = 3522) and people in custody (total, n = 5956) in each phase; focus groups and/or one-to-one interviews with staff (n = 237 across 34 focus groups; n = 38 interviews), people in custody (n = 62 interviews), providers (n = 103 interviews) and users (n = 45 interviews) of prison smoking cessation services and stakeholders elsewhere (n = 19); measurements of second-hand smoke exposure (e.g. 369,208 minutes of static measures in residential areas at three time points); and routinely collected data (e.g. medications dispensed, inpatient/outpatient visits). Results Measures of second-hand smoke were substantially (≈ 90%) reduced post implementation, compared with baseline, largely confirming the views of staff and people in custody that illicit smoking is not a major issue post ban. Several factors that contributed to the successful implementation of the smoke-free policy, now accepted as the ‘new normal’, were identified. E-cigarette use has become common, was recognised (by both staff and people in custody) to have facilitated the transition and raises new issues in prisons. The health economic analysis (lifetime model) demonstrated that costs were lower and the number of quality-adjusted life-years was larger for people in custody and staff in the ‘with smoke-free’ policy period than in the ‘without’ policy period, confirming cost-effectiveness against a £20,000 willingness-to-pay threshold. Limitations The ability to triangulate between different data sources mitigated limitations with constituent data sets. Conclusions To our knowledge, this is the first study internationally to analyse the views of prison staff and people in custody; objective measurements of second-hand smoke exposure and routine health and other outcomes before, during and after the implementation of a smoke-free prison policy; and to assess cost-effectiveness. The results are relevant to jurisdictions considering similar legislation, whether or not e-cigarettes are permitted. The study provides a model for partnership working and, as a multidimensional study of a national prison system, adds to a previously sparse evidence base internationally. Future work Priorities are to understand how to support people in custody in remaining smoke free after release from prison, and whether or not interventions can extend benefits to their families; to evaluate new guidance supporting people wishing to reduce or quit vaping; and to understand how prison vaping practices/cultures may strengthen or weaken long-term reductions in smoking. Study registration This study is registered as Research Registry 4802. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 1. See the NIHR Journals Library website for further project information.

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Smoking Cessation: A Comparison of Two Model Structures

Abstract: The model structures themselves did not influence smoking cessation cost-effectiveness results, but long-term assumptions did. When there is variation in long-term predictions between interventions, economic models need a structure that can reflect this.

Cited by 11 publications

References 36 publications

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

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

Economic evaluation of betibeglogene autotemcel (Beti-cel) gene addition therapy in transfusion-dependent β-thalassemia

Process and impact of implementing a smoke-free policy in prisons in Scotland: TIPs mixed-methods study

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