Cost-effectiveness of smoking cessation to prevent age-related macular degeneration
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BioMed Central
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Cost-effectiveness of smoking cessation to prevent age-related macular degeneration Susan F Hurley*1,2,3, Jane P Matthews1 and Robyn H Guymer4 Address: 1Bainbridge Consultants, 222/299 Queen St, Melbourne, VIC 3000, Australia, 2School of Medicine, Griffith University, 3School of Population Health, The University of Melbourne and 4Macular Research Unit, Department of Ophthalmology, Centre for Eye Research Australia, The University of Melbourne Email: Susan F Hurley* - [email protected]; Jane P Matthews - [email protected]; Robyn H Guymer - [email protected] * Corresponding author
Published: 11 September 2008 Cost Effectiveness and Resource Allocation 2008, 6:18
doi:10.1186/1478-7547-6-18
Received: 14 January 2008 Accepted: 11 September 2008
This article is available from: http://www.resource-allocation.com/content/6/1/18 © 2008 Hurley et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Tobacco smoking is a risk factor for age-related macular degeneration, but studies of ex-smokers suggest quitting can reduce the risk. Methods: We fitted a function predicting the decline in risk of macular degeneration after quitting to data from 7 studies involving 1,488 patients. We assessed the cost-effectiveness of smoking cessation in terms of its impact on macular degeneration-related outcomes for 1,000 randomly selected U.S. smokers. We used a computer simulation model to predict the incidence of macular degeneration and blindness, the number of quality-adjusted life-years (QALYs), and direct costs (in 2004 U.S. dollars) until age 85 years. Cost-effectiveness ratios were based on the cost of the Massachusetts Tobacco Control Program. Costs and QALYs were discounted at 3% per year. Results: If 1,000 smokers quit, our model predicted 48 fewer cases of macular degeneration, 12 fewer cases of blindness, and a gain of 1,600 QALYs. Macular degeneration-related costs would decrease by $2.5 million if the costs of caregivers for people with vision loss were included, or by $1.1 million if caregiver costs were excluded. At a cost of $1,400 per quitter, smoking cessation was cost-saving when caregiver costs were included, and cost about $200 per QALY gained when caregiver costs were excluded. Sensitivity analyses had a negligible impact. The cost per quitter would have to exceed $77,000 for the cost per QALY for smoking cessation to reach $50,000, a threshold above which interventions are sometimes viewed as not cost-effective. Conclusion: Smoking cessation is unequivocally cost-effective in terms of its impact on age-related macular degeneration outcomes alone.
Background There is a strong association between tobacco smoking and age-related macular degeneration.[1] A pooled analysis o
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