A model for cost-effectiveness analyses of smoking cessation interventions applied to a Quit-and-Win contest for mothers of small children

Abstract

Aims: The first aim of this study was to develop a model that predicts health and economic consequences of smoking cessation in Sweden, striving to follow the methodological recommendations to reflect the societal perspective and to use the health measure quality-adjusted life-years (QALYs). The second aim was to apply the model estimates to a smoking cessation intervention. Methods: A Markov cost-effectiveness model was developed on smoking-related lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease. Swedish primary data on medical treatment costs and quality-of-life weights were used, supplemented with secondary data on other societal effects and the disease and death risks. The model simulations were applied to a ``Quit-and-Win'' contest for mothers of pre-school children. In total, 238 women participated, with 34 sustained tobacco-free at 12-month follow-up. Results: The cost-effectiveness model estimates a gain of 0.34 to 0.55 QALYs (discounted 3%), and cost savings of SEK 20—35,000 per female quitter in the age range 15 to 49 years. The cost-effectiveness analyses of the intervention showed intervention costs per quitter of SEK 7,850, and intervention costs per life-years saved (YLS) (discounted 3%) of SEK 13,200. The cost-utility analysis demonstrated cost savings and a gain of 16 QALYs. Conclusions: The cost-utility analysis estimated health gains and cost savings resulting from the ``Quit-and-Win'' contest. As the model estimates on the differences in societal cost between smokers and quitters are considerable, many tobacco control programmes would result in cost savings. The construction of an optimal mix of tobacco control policies, however, demands incremental calculations on a range of programmes.

Keywords

Costs and cost analysis prevention Quit-and-Win smoking cessation

Get full access to this article

View all access options for this article.

References

Godfrey C. , Fowler G. Pharmacoeconomic considerations in the management of smoking cessation. Drugs 2002; 62(Suppl. 2):63—70.

Tengs TO , Adams ME , Pliskin JS , Safran DG , Siegel JE , Weinstein MC , et al. Five-hundred life-saving interventions and their cost-effectiveness . Risk Analysis 1995; 15:369—90.

Nice, Uk Nhs. A rapid and systematic review of the clinical and cost effectiveness of bupropion SR and nicotine replacement therapy (NRT) for smoking cessation. UK: NICE, 2002. Technology Appraisal No. 39.

SBU (The Swedish Council on Technology Assessment in Health Care). Smoking cessation methods. Stockholm: SBU, 1998. SBU report no. 138.

Gold MR , Siegel JE , Russell LB , Weinstein MC , editors. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996.

Hjelmgren J. , Berggren F. , Andersson F. Health economic guidelines: Similarities, differences and some implications. Value Health 2001;4:225—50.

Johansson P. A model for economic evaluations of smoking cessation interventions [available at: www.folkhalsoguiden.se/templates/Publication_1045.aspx

Peto R. , Darby S. , Deo H. , Silcocks P. , Whitley E. , Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: Combination of national statistics with two case-control studies. Br Med J 2000;321:323—9.

Johannesson M. , Hedbrant J. , Jönsson B. A computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention . Linköping : Centrum för utvärdering av medicinsk teknologi (CMT), 1991. CMT rapport 1991:3.

10.

Kannel WB , Wolf PA , Garrison RJ , editors. The Framingham study: An epidemiological investigation of cardiovascular disease. Section 37: The probability of developing certain cardiovascular diseases in eight years at specified values of some characteristics. USA: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1987. NIH Publication No. 87—2284.

11.

Lundbäck B. , Lindberg A. , Lindström M. , Rönmark E. , Jonsson AC , Jönsson E. , et al. Not 15 but 50% of smokers develop COPD? Report from the Obstructive Lung Disease in Northern Sweden Studies . Respir Med 2003 ;97:115—22.

12.

US Department of Health and Human Services. The health benefits of smoking cessation. USA: US Department of Health and Human Services, Public Health Service, Centres for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1990. DHHS Publication No. (CDC) 90—8416.

13.

Hilleman DE , Dewan N. , Malesker M. , Friedman M. Pharmacoeconomic evaluation of COPD. Chest 2000;118:1278—85.

14.

Holm LE , Gunnarskog J. , Stenbeck M. In: Stenbeck M, Rosén M, editors. Cancer survival in Sweden in 1961—1991 . Acta Oncol 1995;34(Suppl. 4):39—47.

15.

Kannel WB , Wolf PA , Garrison RJ , editors. The Framingham study: An epidemiological investigation of cardiovascular disease. Section 35: Survival following initial cardiovascular events: 30 year follow-up. USA: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1988. NIH Publication No. 88—2969.

16.

Jansson S-A. , Andersson F. , Borg S. , Ericsson Å. , Jönsson E. , Lundbäck B. Costs of COPD in Sweden according to disease severity. Chest 2002;122:1994—2002.

17.

Rydén-Bergsten T. , Andersson F. The health care costs of heart failure in Sweden. J Intern Med 1999;246:275—284.

18.

Andersson F. , Kartman B. The cost of angina pectoris in Sweden. Pharmacoeconomics 1995;8:233—44.

19.

Glader E-L. , Stegmayr B. , Johansson L. , Hulter-Åsberg K. , Staaf A. , Wester PO Slaganfall — och sedan? Omfattande hjälpbehov två år efter slaganfallet, visar stor nationell studie (Stroke —and then? Considerable need of assistance two years after stroke, according to large national study). Läkartidningen 2001 ;98:4462—7.

20.

Claesson L. , Gosman-Hedström G. , Johannesson M. , Fagerberg B. , Blomstrand C. Resource utilization and costs of Stroke Unit care integrated in a care continuum: A 1-year controlled, prospective, randomized study in elderly patients. Stroke 2000;31:2569—77.

21.

Zethraeus N. , Molin T. , Henriksson P. , Jönsson B. Costs of coronary heart disease and stroke: the case of Sweden. J Intern Med 1999;246:151—9.

22.

Von Koch L. , de Pedro-Cuesta J. , Kostulas V. , Almazán J. , Widen Holmqvist L. Randomized controlled trial of rehabilitation at home after stroke: One-year follow-up of patient outcome, resource use and cost. Cerebrovasc Dis 2001;12:131—8.

23.

Ford ES , Kelly AE , Teutsch SM , Thacker SB , Garbe PL Radon and lung cancer: A cost-effectiveness analysis. Am J Public Health 1999;89:351—7.

24.

Ekman M. , Zethraeus N. , Jönsson B. Cost effectiveness of Bisoprolol in the treatment of chronic congestive heart failure in Sweden. Pharmacoeconomics 2001;19: 901—16.

25.

Burström K. , Johannesson M. , Diderichsen F. Health-related quality of life by disease and socio-economic group in the general population in Sweden . Health Policy 2001;55: 51—69.

26.

Tillgren P. , Eriksson L. , Guldbrandsson K. , Spiik M. Impact of direct mail as a method to recruiting smoking mothers into a ``Quit and Win'' contest . J Health Communication 2000;5:293—303.

27.

Lichtenstein E. , Glasgow RE

Smoking cessation: what have we learned over the past decade?

J Consult Clin Psychol 1992 ;60:518—27.

28.

Evans WK , Will BP , Berthelot J-M. , Wolfson MC The cost of managing lung cancer in Canada. Oncology 1995;9(Suppl.):147—53.

29.

Lightwood JM , Glantz SA Short-term economic and health benefits of smoking cessation: Myocardial infarction and stroke. Circulation 1997;96:1089—96.

30.

Phillips CJ , Prowle MJ Economics of a reduction in smoking: case study from Heartbeat Wales. J Epidemiol Community Health 1993;47:215—23.

31.

Orme ME , Hogue SL , Kennedy LM , Paine AC , Godfrey C. Development of the health and economic consequences of smoking interactive model. Tob Control 2001;10:55—61.

32.

Tengs TO , Osgood ND , Chen LL The cost-effectiveness of intensive national school-based anti-tobacco education: Results from the Tobacco Policy Model. Prev Med 2001;33:558—70.

33.

Wang LY , Crossett LS , Lowry R. , Sussman S. , Dent CW Cost-effectiveness of a school-based tobacco-use prevention program. Arch Pediatr Adolesc Med 2001;155:1043—50.

34.

Kiiskinen U. , Vartiainen E. , Puska P. , Pekurinen M. Smoking-related costs among 25 to 59 year-old males in a 19-year individual follow-up. Eur J Public Health 2002;12:145—51.

35.

Cohen D. , Barton G. The costs to society of smoking cessation. Thorax 1998;53(Suppl. 2):S38—S42.

36.

Barendregt JJ , Bonneux L. , van der Maas PJ The health care costs of smoking. N Engl J Med 1997;337:1052—7.

37.

Oster G. , Huse DM , Delea TE , Colditz GA Cost-effectiveness of nicotine gum as an adjunct to physician's advice against cigarette smoking. JAMA 1986;256:1315—18.

38.

Fiscella K. , Franks P. Cost-effectiveness of the transdermal nicotine patch as an adjunct to physicians' smoking cessation counseling. JAMA 1996;275:1247—51.

39.

Rosendahl KI , Galanti MR , Gilljam H. , Ahlbom A. Smoking mothers and snuffing fathers: behavioral influences on youth tobacco use in a Swedish cohort. Tob Control 2003;12:74—8.

40.

Bains N. , Pickett W. , Hoey J. The use and impact of incentives in population-based smoking cessation programs: A review. Am J Health Promot 1998;12:307—20.

41.

Mudde AN , de Vries H. , Strecher VJ Cost-effectiveness of smoking cessation modalities: Comparing apples with oranges. Prev Med 1996;25:708—16.

42.

Tillgren P. , Rosén M. , Haglund BJA , Ainetdin T. , Lindholm L. , Holm L-E. Cost-effectiveness of a tobacco ``Quit and Win'' contest in Sweden. Health Policy 1993 ;26:43—53.