Encouraging Smokers to Quit
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Pharmacoeconomics 2006; 24 (5): 453-464 1170-7690/06/0005-0453/$39.95/0 © 2006 Adis Data Information BV. All rights reserved.
Encouraging Smokers to Quit The Cost Effectiveness of Reimbursing the Costs of Smoking Cessation Treatment Janneke Kaper,1 Edwin J. Wagena,2 Constant P. van Schayck1 and Johan L. Severens3 1 2 3
Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands Pulmonary Rehabilitation Centre, Hornerheide, Horn, The Netherlands Department of Health Organisation, Policy and Economics, Maastricht University and Department of Clinical Epidemiology and MTA, University Hospital, Maastricht, The Netherlands
Abstract
Background: Smoking cessation should be encouraged in order to increase life expectancy and reduce smoking-related healthcare costs. Results of a randomised trial suggested that reimbursing the costs of smoking cessation treatment (SCT) may lead to an increased use of SCT and an increased number of quitters versus no reimbursement. Objective: To assess whether reimbursement for SCT is a cost-effective intervention (from the Dutch societal perspective), we calculated the incremental costs per quitter and extrapolated this outcome to incremental costs per QALY saved versus no reimbursement. Methods: In the reimbursement trial, 1266 Dutch smokers were randomly assigned to the intervention or control group using a randomised double consent design. Reimbursement for SCT was offered to the intervention group for a period of 6 months. No reimbursement was offered to the control group. Prolonged abstinence from smoking was determined 6 months after the end of the reimbursement period. The QALYs gained from quitting were calculated until 80 years of age using data from the US. Costs (year 2002 values) were determined from the societal perspective during the reimbursement period (May–November 2002). Benefits were discounted at 4% per annum. The uncertainty of the incremental cost-effectiveness ratios was estimated using non-parametric bootstrapping. Results: Eighteen participants in the control group (2.8%) and 35 participants in the intervention group (5.5%) successfully quit smoking. The costs per participant were €291 and €322, respectively. If society is willing to pay €1000 or €10 000 for an additional 12-month quitter, the probability that reimbursement for SCT would be cost effective was 50% or 95%, respectively. If society is willing to pay €18 000 for a QALY, the probability that reimbursement for SCT would be cost
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effective was 95%. However, the external validity of the extrapolation from quitters to QALYs is uncertain and several assumptions had to be made. Conclusion: Reimbursement for SCT may be cost effective if Dutch society is willing to pay €10 000 for an additional quitter or €18 000 for a QALY.
Smoking is one of the most avoidable causes of death and disability in developed countries[1] and accounts for up to 15% of a country’s total annual healthcare costs.[2] To increase life expect
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