Cost-effectiveness of extended cessation treatment for older smokers.
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ABSTRACT:
SUBMITTER: Barnett PG
PROVIDER: S-EPMC4020783 | biostudies-literature | 2014 Feb
REPOSITORIES: biostudies-literature
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Cost-effectiveness of extended cessation treatment for older smokers.
Barnett Paul G PG Wong Wynnie W Jeffers Abra A Munoz Ricardo R Humfleet Gary G Hall Sharon S
Addiction (Abingdon, England) 20131213 2
<h4>Aims</h4>We examined the cost-effectiveness of extended smoking cessation treatment in older smokers.<h4>Design</h4>Participants who completed a 12-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy.<h4>Setting</h4>A free-standing smoking cessation clinic.<h4>Participants</h4>A total of 402 smokers aged 50 years and older were recruited from the community.<h4>Measurements</h4>The trial measured biochem ...[more]
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Project description:Tobacco dependence treatments achieve abstinence rates of 25-30% at 1 year. Low rates may reflect failure to conceptualize tobacco dependence as a chronic disorder. The aims of the present study were to determine the efficacy of extended cognitive behavioral and pharmacological interventions in smokers > or = 50 years of age, and to determine if gender differences in efficacy existed.Open randomized clinical trial.A free-standing, smoking treatment research clinic.A total of 402 smokers of > or = 10 cigarettes per day, all 50 years of age or older.Participants completed a 12-week treatment that included group counseling, nicotine replacement therapy (NRT) and bupropion. Participants, independent of smoking status, were then assigned randomly to follow-up conditions: (i) standard treatment (ST; no further treatment); (ii) extended NRT (E-NRT; 40 weeks of nicotine gum availability); (iii) extended cognitive behavioral therapy (E-CBT; 11 cognitive behavioral sessions over a 40-week period); or (iv) E-CBT plus E-NRT (E-combined; 11 cognitive behavioral sessions plus 40 weeks nicotine gum availability).Primary outcome variable was 7-day point prevalence cigarette abstinence verified biochemically at weeks 24, 52, 64 and 104.The most clinically important findings were significant main effects for treatment condition, time and the treatment x time interaction. The E-CBT condition produced high cigarette abstinence rates that were maintained throughout the 2-year study period [(week 24 (58%), 52 (55%), 64 (55%) and 104 (55%)], and was significantly more effective than E-NRT and ST across that period. No other treatment condition was significantly different to ST. No effects for gender were found.Extended cognitive behavioral treatments can produce high and stable cigarette abstinence rates for both men and women. NRT does not add to the efficacy of extended CBT, and may hamper its efficacy. Research is needed to determine if these results can be replicated in a sample with a greater range of ages, and improved upon with the addition of medications other than NRT.
| S-EPMC2718733 | biostudies-literature
Project description:CONTEXT:To provide a systematic review and cost-effectiveness analysis on smoking interventions targeting smokers not ready to quit, a population that makes up approximately 32% of current smokers. EVIDENCE ACQUISITION:Twenty-two studies on pharmacological, behavioral, and combination smoking-cessation interventions targeting smokers not ready to quit (defined as those who reported they were not ready to quit at the time of the study) published between 2000 and 2017 were analyzed. The effectiveness (measured by the number needed to treat) and cost effectiveness (measured by costs per quit) of interventions were calculated. All data collection and analyses were performed in 2017. EVIDENCE SYNTHESIS:Smoking interventions targeting smokers not ready to quit can be as effective as similar interventions for smokers ready to quit; however, costs of intervening on this group may be higher for some intervention types. The most cost-effective interventions identified for this group were those using varenicline and those using behavioral interventions. CONCLUSIONS:Updating clinical recommendations to provide cessation interventions for this group is recommended. Further research on development of cost-effective treatments and effective strategies for recruitment and outreach for this group are needed. Additional studies may allow for more nuanced comparisons of treatment types among this group.
| S-EPMC6055474 | biostudies-literature
Project description:We examined the cost-effectiveness of smoking cessation integrated with treatment for post-traumatic stress disorder (PTSD).Smoking veterans receiving care for PTSD (N = 943) were randomized to care integrated with smoking cessation versus referral to a smoking cessation clinic. Smoking cessation services, health care cost and utilization, quality of life, and biochemically-verified abstinence from cigarettes were assessed over 18-months of follow-up. Clinical outcomes were combined with literature on changes in smoking status and the effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness over a lifetime horizon. We discounted cost and outcomes at 3% per year and report costs in 2010 US dollars.The mean of smoking cessation services cost was $1286 in those randomized to integrated care and $551 in those receiving standard care (P < .001). There were no significant differences in the cost of mental health services or other care. After 12 months, prolonged biochemically verified abstinence was observed in 8.9% of those randomized to integrated care and 4.5% of those randomized to standard care (P = .004). The model projected that Integrated Care added $836 in lifetime cost and generated 0.0259 quality adjusted life years (QALYs), an incremental cost-effectiveness ratio of $32 257 per QALY. It was 86.0% likely to be cost-effective compared to a threshold of $100 000/QALY.Smoking cessation integrated with treatment for PTSD was cost-effective, within a broad confidence region, but less cost-effective than most other smoking cessation programs reported in the literature.
| S-EPMC5942533 | biostudies-literature
Project description:There is a lack of evidence of the relative cost-effectiveness of proactive telephone counseling (PTC) and Web-based delivery of smoking cessation services in conjunction with pharmacotherapy. We calculated the differential cost-effectiveness of three behavioral smoking cessation modalities with varenicline treatment in a randomized trial of current smokers from a large health system. Eligible participants were randomized to one of three smoking cessation interventions: Web-based counseling (n=401), PTC (n=402), or combined PTC-Web counseling (n=399). All participants received a standard 12-week course of varenicline. The primary outcome was a 7-day point prevalent nonsmoking at the 6month follow-up. The Web intervention was the least expensive followed by the PTC and PTC-Web groups. Costs per additional 6-month nonsmoker and per additional lifetime quitter were $1,278 and $2,601 for Web, $1,472 and $2,995 for PTC, and $1,617 and $3,291 for PTC-Web. Cost per life-year (LY) and quality-adjusted life-year (QALY) saved were $1,148 and $1,136 for Web, $1,320 and $1,308 for PTC, and $1,450 and $1,437 for PTC-Web. Based on the cost per LY and QALY saved, these interventions are among the most cost-effective life-saving medical treatments. Web, PTC, and combined PTC-Web treatments were all highly cost-effective, with the Web treatment being marginally more cost-effective than the PTC or combined PTC-Web treatments.
| S-EPMC3124766 | biostudies-literature
Project description:AimsTo estimate the cost-effectiveness at population-level of the OPT-IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low-income persons (e.g. Medicaid).DesignCost-effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT-IN) randomized control trial.SettingThe trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective.ParticipantsData were used from 2406 smokers who were randomized into the intervention or comparator groups.Intervention and comparatorThe intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)-approved smoking cessation medications and the state's telephone quitline.MeasurementsSmoking status, quality of life and health-care use at varying times, including at baseline and 1 year.FindingsThe OPT-IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population-level, 6-month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life-time cost and generated 0.005 additional quality-adjusted life-years (QALYs), with an expected incremental cost-effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost-effective against a willingness-to-pay threshold of $50 000/QALY approximately 68% of the time.ConclusionsPopulation-level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population-level quit rates and was cost-effective at various willingness-to-pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population-level proactive tobacco cessation outreach programs are judged to be highly cost-effective over the long term.
| S-EPMC6899559 | biostudies-literature
Project description:Introduction:The effectiveness of varenicline compared with nicotine replacement therapy (NRT) in achieving smoking cessation in older smokers has not been investigated. This study prospectively compared the effectiveness of varenicline relative to NRT in smokers aged 25-54 years and separately in smokers aged 55 years or older. Methods:Among 13 397 smokers participating in the Smoking Cessation Program in Taiwan, 2012-2015, 6336 (19.2%, aged ?55) received varenicline and 7061 received NRT patch or gum (23.2%, aged ?55). Participants self-reported smoking behaviors by phone interview after 6 months. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for 7-day, 1-month, and 6-month point-prevalence abstinence. Age-specific models adjusted for sex, education, marital status, smoke-years, nicotine dependence, medical institution, clinic visit number, and duration of medication received. Results:Among smokers aged 25-54 years, varenicline users had a greater point-prevalence abstinence than NRT users (e.g., 7-day point-prevalence: 34.0% vs. 23.5%), with adjusted OR ranging from 1.23 (CI: 1.09-1.39; 6-month point-prevalence) to 1.37 (CI: 1.24-1.50; 1-month point-prevalence). Among smokers aged 55 years or older, point-prevalence was similar for varenicline and NRT users (e.g., 7-day point-prevalence: 32.3% vs. 33.1%), and ORs did not suggest that varenicline has greater effectiveness than NRT. Sex and level of nicotine dependence did not modify the age-specific effectiveness of varenicline relative to NRT. Conclusions:Varenicline did not offer greater effectiveness in achieving abstinence than NRT for smokers 55 years or older, whereas it was more effective than NRT in smokers aged 25-54 years. These findings highlighted the need for age-specific approaches for effective tobacco control. Implications:In this prospective investigation of a national cohort, older smokers (aged ?55 years) who received varenicline did not have a greater point-prevalence abstinence after 6 months compared with those who used NRT patch or gum. Younger smokers (aged 25-54 years) who received varenicline had a greater likelihood of abstinence than NRT users. Sex and nicotine dependence did not modify the age-specific effectiveness of varenicline relative to NRT patch or gum. Age-appropriate approaches for effective tobacco control are needed.
| S-EPMC6319447 | biostudies-literature
Project description:We examined the cost-effectiveness of smoking cessation treatment for psychiatric inpatients.Smokers, regardless of intention to quit, were recruited during psychiatric hospitalization and randomized to receive stage-based smoking cessation services or usual aftercare. Smoking cessation services, quality of life, and biochemically verified abstinence from cigarettes were assessed during 18 months of follow-up. A Markov model of cost-effectiveness over a lifetime horizon was constructed using trial findings and parameters obtained in a review of the literature on quit and relapse rates and the effect of smoking on health care cost, quality of life, and mortality.Among 223 smokers randomized between 2006 and 2008, the mean cost of smoking cessation services was $189 in the experimental treatment group and $37 in the usual care condition (P < .001). At the end of follow-up, 18.75% of the experimental group was abstinent from cigarettes, compared to 6.80% abstinence in the usual care group (P < .05). The model projected that the intervention added $43 in lifetime cost and generated 0.101 additional quality-adjusted life-years (QALYs), an incremental cost-effectiveness ratio of $428 per QALY. Probabilistic sensitivity analysis found the experimental intervention was cost-effective against the acceptance criteria of $50,000/QALY in 99.0% of the replicates.A cessation intervention for smokers identified in psychiatric hospitalization did not result in higher mental health care costs in the short-run and was highly cost-effective over the long-term. The stage-based intervention was a feasible and cost-effective way of addressing the high smoking prevalence in persons with serious mental illness.ClinicalTrials.gov identifier: NCT00136812.
| S-EPMC4988964 | biostudies-literature
Project description:Background:Over half of young adults with schizophrenia smoke. Quitting before age 30 could prevent some of the disparate morbidity and mortality due to smoking-related diseases. However, little research has addressed smoking in this group nor evaluated strategies to help young adults with schizophrenia quit smoking. Methods:We compared demographic and smoking-related characteristics of young adults and those over 30 years of age among 184 smokers with schizophrenia. With a series of regression models, we assessed whether age, gender, smoking characteristics, social norms, attitudes, and perceived behavioral control predicted intention to quit smoking and to use cessation treatments. Results:Young adults had smoked for fewer years, had lower nicotine dependence, and had lower breath carbon monoxide levels than those over 30, yet awareness of the harms of smoking and readiness to quit were similar between groups. Attitudes about smoking, attitudes about cessation treatment, social norms for cessation treatment, and perceived behavioral control for cessation treatment significantly predicted intention to use cessation treatment. Age was not a predictor of intention to quit, nor to use cessation treatment. Conclusions:Young adults with schizophrenia are amenable to smoking cessation intervention. Increasing awareness of the safety, efficacy and access to cessation treatments among smokers with schizophrenia and also among those in their social network may improve use of effective cessation treatment. These strategies may enhance the standard educational approach (increasing awareness of harms). Research is needed to evaluate such intervention strategies in smokers with schizophrenia of all ages.
| S-EPMC5988490 | biostudies-literature
Project description:INTRODUCTIONWhile understanding factors that lead to successful adolescent smoking cessation outcomes is necessary, it is also prudent to determine factors and conditions that contribute to failure to quit smoking. The present study posits that adolescents’ proximal environments, such as schools, may influence cessation treatment outcomes.METHODSUsing aggregated and geographically-referenced data from multi-year school-based cessation trials with 14-19 year olds seeking cessation in 5 States of the USA, the present study developed and applied a tobacco-specific socio-spatial model inclusive of Hierarchical Linear Modeling. Specifically, this novel approach spatially joined individual data files (n=8855) with measures of school (n=807) and county socio-economic factors. Once linked multi-level analyses explored the extent to which cessation treatment failure was explained by the interplay of individual, school and county-level factors. Treatment was deemed as failing to meet its primary goals if participants continued to smoke cigarettes, measured 3-months post baseline.RESULTSTen per cent of the variation in cessation treatment failure was attributable to school-level variables. Adolescent smokers were more likely to experience failure to quit in: a) school districts with large percentages of the population having less than high-school education, and b) schools with a higher ratio of students to teachers. The strength of the relationship between cessation self-efficacy and treatment success was further weakened among adolescents attending schools with higher percentages of students eligible for free or reduced lunch programs.CONCLUSIONSFindings implicate school-level socio-economic disadvantage as a significant factor inhibiting cessation, regardless of adolescent self-efficacy to quit smoking. Understanding the interplay of proximal school environments and individual-level factors may provide insights to educators, policy makers and practitioners into the complexities that inhibit or strengthen an adolescent’s smoking cessation treatment experience.
| S-EPMC7205073 | biostudies-literature
Project description:IntroductionProject CLIQ (Community Link to Quit) was a proactive population-outreach strategy using an electronic health records-based smoker registry and interactive voice recognition technology to connect low- to moderate-income smokers with cessation counseling, medications, and social services. A randomized trial demonstrated that the program increased cessation. We evaluated the cost-effectiveness of CLIQ from a provider organization's perspective if implemented outside the trial framework.MethodsWe calculated the cost, cost per smoker, incremental cost per additional quit, and, secondarily, incremental cost per additional life year saved of the CLIQ system compared to usual care using data from a 2011-2013 randomized trial assessing the effectiveness of the CLIQ system. Sensitivity analyses considered economies of scale and initial versus ongoing costs.ResultsOver a 20-month period (the duration of the trial) the program cost US $283 027 (95% confidence interval [CI] $209 824-$389 072) more than usual care in a population of 8544 registry-identified smokers, 707 of whom participated in the program. The cost per smoker was $33 (95% CI 28-40), incremental cost per additional quit was $4137 (95% CI $2671-$8460), and incremental cost per additional life year saved was $7301 (95% CI $4545-$15 400). One-time costs constituted 28% of costs over 20 months. Ongoing costs were dominated by personnel costs (71% of ongoing costs). Sensitivity analyses showed sharp gains in cost-effectiveness as the number of identified smokers increased because of the large initial costs.ConclusionsThe CLIQ system has favorable cost-effectiveness compared to other smoking cessation interventions. Cost-effectiveness will be greatest for health systems with high numbers of smokers and with the high smoker participation rates.ImplicationsHealth information systems capable of establishing registries of patients who are smokers are becoming more prevalent. This economic analysis illustrates the cost implications for health care systems adopting a proactive tobacco treatment outreach strategy for low- and middle-income smokers. We find that under many circumstances, the CLIQ system has a favorable cost-per-quit compared to other population-based tobacco treatment strategies. The strategy could be widely disseminable if health systems leverage economies of scale.
| S-EPMC5896510 | biostudies-literature