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Cost efficacy of smoking cessation interventions

This article discusses the health benefits of smoking cessation, the effectiveness of different interventions, and the cost-effectiveness calculations associated with quitting smoking. It highlights the increase in life expectancy, reduction in morbidity, and other benefits of quitting smoking, such as reducing the risks in pregnancy and improving prognosis in patients with COPD. The article also presents the effectiveness of various smoking cessation interventions, such as face-to-face counseling, NRT, and medication. Cost-effectiveness calculations are provided, emphasizing the value of these interventions in reducing premature death. The article concludes that while clinical interventions are important, government action on price and public awareness campaigns are crucial in reducing smoking prevalence.

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Cost efficacy of smoking cessation interventions

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  1. Cost efficacy of smoking cessation interventions Robert West University College London Logroño, October 2006 www.rjwest.co.uk

  2. Outline • Health benefits of cessation • Effectiveness of cessation interventions • Cost-effectiveness calculation

  3. Benefits of smoking cessation: life-expectancy • Stopping smoking permanently increases life expectancy by: • 9 years if stopped around age 40 years • 6 years if stopped around age 50 years • 3 years if stopped around age 60 years • For every year that smoking cessation is brought forward, life-expectancy increases by 3 months Doll R et al. BMJ. 2004;328:1519–1527

  4. Benefits of smoking cessation: morbidity • Smokers spend more of their lives with pain, ill health and disability from: • Chronic Obstructive Lung Disease • Coronary Heart Disease • Peripheral vascular disease • Blindness • Deafness • Dementia • Stroke • Osteoporosis West, R (2006) British Medical Bulletin, in press

  5. Benefits of smoking cessation: smoking in pregnancy • Stopping smoking before or early in pregnancy reduces risk of: • Infertility • Spontaneous abortion • Stillbirth • Low birth weight (with later risk of COPD and heart disease) • Conduct disorder and criminality in the offspring • Sudden infant death syndrome in the offspring West, R (2006) British Medical Bulletin, in press

  6. Benefits of smoking cessation: secondary prevention • Smoking cessation: • normalises the rate of decline in lung function in patients with COPD, and reduces the rate of exacerbations and mortality from respiratory and cardiovascular diseases • improves prognosis in patients with lung cancer Anthonisen N, et al Ann Int Med 2005; 142, 233-239 Kawahara M, et al Br J Cancer 1998;78:409-12.

  7. Effectiveness of smoking cessation interventions • Percentage of smokers who achieve 6 months of continuous abstinence who would not have done so otherwise: • Face-to-face individual counselling 2-8% • Pro-active telephone counselling 2-4% • Group counselling/support 3-9% • NRT 5-8% • Bupropion 7-13% • Varenicline 14-22% These estimates and those in the following graphs are approximate, based on a simple analysis assuming no heterogeneity across studies

  8. Effect of face-to-face individual support Using only studies with ≥6 months’ continuous abstinence and biochemical verification

  9. Effect of group support Using only studies with ≥12 months’ continuous abstinence and biochemical verification

  10. Effect of telephone counselling Cochrane review: >6 month cessation not validated

  11. Effect of tailored internet support Not biochemically verified

  12. Effect of NRT Cochrane: LI: Low intensity behavioural support; HI: High intensity behavioural support RTS: Reduce To Stop; Combination: various combinations versus single NRT types; Population: NRT versus no NRT in population samples without behavioural support (ATTEMPT – cohort study, not RCT)

  13. Effect of nortriptyline, bupropion and varenicline For bupropion and nortriptyline data from Cochrane: ≥6 months’ continuous abstinence and biochemical verification; varenicline 6 month continuous abstinence data from JAMA 2006; blue shading shows effect on 12 month continuous abstinence rates of further 12w varenicline vs placebo in smokers abstinence at 12w

  14. Cost effectiveness calculations • Approximately 50% of those who abstain for 6 months achieve long-term cessation (8 years or more) • Thus smoking cessation interventions typically achieve an increase of 1% to 7% permanent cessation on worst case estimates • Without treatment, the average age of quitting of a 40 year-old smoker is ~ 65 years • Therefore a 40 year-old smoker who is help to stop will gain an average 6 years of life (9 years minus 3 years) • Treating 100 40 year-old smokers will yield a minimum of 6 to 42 years of life years • If a treatment episode costs an average 150 euros, this represents a cost per life year gained of 360 to 2500 euros undiscounted (~720 to 5000 euros discounted at 3% for 20 years) • The UK National Institute of Clinical Excellence has an informal benchmark of 30,000 euros per quality-adjusted life year gained as threshold for value for money for the National Health Service

  15. Conclusions • Current treatments to aid smoking cessation are highly cost-effective for reducing premature death • This does not take account of prevention of pain and disability • Even the least effective methods represent excellent value for money • These clinical interventions are not a substitute for government action on price, smoke-free workplaces and media campaigns which will reduce overall smoking prevalence

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