The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop

Abstract

BackgroundThe txt2stop trial has shown that mobile-phone-based smoking cessation support doubles biochemically validated quitting at 6 months. This study examines the cost-effectiveness of smoking cessation support delivered by mobile phone text messaging.MethodsThe lifetime incremental costs and benefits of adding text-based support to current practice are estimated from a UK NHS perspective using a Markov model. The cost-effectiveness was measured in terms of cost per quitter, cost per life year gained and cost per QALY gained. As in previous studies, smokers are assumed to face a higher risk of experiencing the following five diseases: lung cancer, stroke, myocardial infarction, chronic obstructive pulmonary disease, and coronary heart disease (i.e. the main fatal or disabling, but by no means the only, adverse effects of prolonged smoking). The treatment costs and health state values associated with these diseases were identified from the literature. The analysis was based on the age and gender distribution observed in the txt2stop trial. Effectiveness and cost parameters were varied in deterministic sensitivity analyses, and a probabilistic sensitivity analysis was also performed.FindingsThe cost of text-based support per 1,000 enrolled smokers is £16,120, which, given an estimated 58 additional quitters at 6 months, equates to £278 per quitter. However, when the future NHS costs saved (as a result of reduced smoking) are included, text-based support would be cost saving. It is estimated that 18 LYs are gained per 1,000 smokers (0.3 LYs per quitter) receiving text-based support, and 29 QALYs are gained (0.5 QALYs per quitter). The deterministic sensitivity analysis indicated that changes in individual model parameters did not alter the conclusion that this is a cost-effective intervention. Similarly, the probabilistic sensitivity analysis indicated a >90 % chance that the intervention will be cost saving.InterpretationThis study shows that under a wide variety of conditions, personalised smoking cessation advice and support by mobile phone message is both beneficial for health and cost saving to a health system.

Can text messages increase safer sex behaviours in young people? Intervention development and pilot randomised controlled trial

“…8 Mobile phones provide a broad-reach delivery mechanism for effective, low-cost health behaviour support. [9][10][11] Support via text message is likely to be acceptable to young people and might increase safer sexual health behaviours. Mobile phones are able to provide confidential and non-judgemental support, which is essential for a sexual health intervention.…”

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

“…A significant part of the intervention was smoking cessation programmes, either pharmacotherapy 4, 5, 36, 37, 38, 40, 41, 48, 50, 51, 53, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, behavioural therapy 6, 42, 47, 66, 67, 68, 69 or a combination of these 33, 34, 35, 43, 45, 46, 49, 52, 54, 70, 71, 72, 73, 74, 75. Several studies evaluated wider tobacco control interventions 39, 44, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, whereas five studies included both smoking cessation programmes and tobacco control interventions 89, 90, 91, 92, 93.…”

“…In total, 23 of 64 studies reported QALY as their main outcome 5, 35, 38, 40, 41, 47, 48, 49, 56, 58, 59, 61, 62, 63, 65, 69, 70, 76, 78, 81, 86, 88, 94, followed by life years (LY) gained ( n  = nine of 64) 33, 43, 46, 66, 67, 68, 73, 74, 89 or a combination of these ( n  = 12 of 64) 4, 6, 35, 36, 37, 39, 42, 44, 57, 77, 80, 83. Five of 64 studies reported disability adjusted life years (DALY) as their main outcome 60, 82, 90, 91, 92, and only four of 64 (incremental) net benefit 52, 53, 55, 71.…”

A Church-Based Weight Loss Intervention in African American Adults using Text Messages (LEAN Study): Cluster Randomized Controlled Trial (Preprint)

“…[8][9][10][11][12] mHealth technologies also have the ability to affect the amount of treatment delivered by increasing communication between study staff and participants, providing behavioral strategies, and prompting behavior change. [13] Several reviews [14][15][16][17][18][19] have shown that mHealth interventions can be effective in promoting weight loss.…”