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Health economics
Research
Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up
  1. Inna Feldman1,
  2. Asgeir Runar Helgason2,3,
  3. Pia Johansson4,
  4. Åke Tegelberg5,6,
  5. Eva Nohlert7
  1. 1 Department of Public Health and Caring Science, Uppsala Universitet, Uppsala, Sweden
  2. 2 Department of Public Health Sciences, Social Medicine, Karolinska Institutet, Stockholm, Sweden
  3. 3 Reykjavik University and Icelandic Cancer Society, Reykjavik University, Reykjavik, Iceland
  4. 4 Public Health and Economics, Stockholm, Sweden
  5. 5 Centre for Clinical Research, Uppsala University, Hospital of Vastmanland, Västerås, Sweden
  6. 6 Faculty of Odontology, Malmö University, Malmö, Sweden
  7. 7 Centre for Clinical Research, Uppsala University and Region Vastmanland, Västerås, Sweden
  1. Correspondence to Dr Inna Feldman; inna.feldman{at}pubcare.uu.se

Abstract

Objectives The 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 measures Intervention 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.

Setting The study was conducted in dental clinics in Sweden.

Participants 294 smokers aged 19–71 years were included in the study.

Interventions Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT).

Results The 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.

Conclusion CEA favours the more costly HIT if decision makers are willing to spend at least €4000/QALY for tobacco cessation treatment.

  • smoking cessation
  • cost-effectivenes
  • long-term sustainability

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2019-030934

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    Footnotes

    • Contributors IF and EN conceived and designed the study and drafted the manuscript. Modelling and economic evaluation was carried out by IF and PJ. ARH, ÅT and EN were responsible for clinical evaluation of the smoking cessation study. All the authors (IF, ARH, ÅT, PJ and EN) contributed to the writing process and have approved the final manuscript.

    • Funding This study was funded by grants from the County Council of Västmanland, Sweden (LTV 3999) and Swedish Research Council for Health, Working Life and Welfare (FORTE), grant number 2014-1399.

    • Competing interests None declared.

    • Ethics approval The original study, as well as the long-term follow-up, was approved by the Ethical Committee at Uppsala University (Dnr:Ups 02–457, Dnr: 2010/172).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.