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Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment.

ABSTRACT: 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.

SUBMITTER: Barnett PG

PROVIDER: S-EPMC5942533 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment.

Barnett Paul G PG Jeffers Abra A Smith Mark W MW Chow Bruce K BK McFall Miles M Saxon Andrew J AJ

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 20150504 3

<h4>Introduction</h4>We examined the cost-effectiveness of smoking cessation integrated with treatment for post-traumatic stress disorder (PTSD).<h4>Methods</h4>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. Clinica ...[more]

PMID: 25943761

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Project description:ContextMost smokers with mental illness do not receive tobacco cessation treatment.ObjectiveTo determine whether integrating smoking cessation treatment into mental health care for veterans with posttraumatic stress disorder (PTSD) improves long-term smoking abstinence rates.Design, setting, and patientsA randomized controlled trial of 943 smokers with military-related PTSD who were recruited from outpatient PTSD clinics at 10 Veterans Affairs medical centers and followed up for 18 to 48 months between November 2004 and July 2009.InterventionSmoking cessation treatment integrated within mental health care for PTSD delivered by mental health clinicians (integrated care [IC]) vs referral to Veterans Affairs smoking cessation clinics (SCC). Patients received smoking cessation treatment within 3 months of study enrollment.Main outcome measuresSmoking outcomes included 12-month bioverified prolonged abstinence (primary outcome) and 7- and 30-day point prevalence abstinence assessed at 3-month intervals. Amount of smoking cessation medications and counseling sessions delivered were tested as mediators of outcome. Posttraumatic stress disorder and depression were repeatedly assessed using the PTSD Checklist and Patient Health Questionnaire 9, respectively, to determine if IC participation or quitting smoking worsened psychiatric status.ResultsIntegrated care was better than SCC on prolonged abstinence (8.9% vs 4.5%; adjusted odds ratio, 2.26; 95% confidence interval [CI], 1.30-3.91; P = .004). Differences between IC vs SCC were largest at 6 months for 7-day point prevalence abstinence (78/472 [16.5%] vs 34/471 [7.2%], P < .001) and remained significant at 18 months (86/472 [18.2%] vs 51/471 [10.8%], P < .001). Number of counseling sessions received and days of cessation medication used explained 39.1% of the treatment effect. Between baseline and 18 months, psychiatric status did not differ between treatment conditions. Posttraumatic stress disorder symptoms for quitters and nonquitters improved. Nonquitters worsened slightly on the Patient Health Questionnaire 9 relative to quitters (differences ranged between 0.4 and 2.1, P = .03), whose scores did not change over time.ConclusionAmong smokers with military-related PTSD, integrating smoking cessation treatment into mental health care compared with referral to specialized cessation treatment resulted in greater prolonged abstinence.Trial registrationclinicaltrials.gov Identifier: NCT00118534.

Project description:BackgroundThis study estimated the cost-effectiveness of four strategies enhancing the quality and accessibility of Brief Intervention (BI) service for smoking cessation in Thailand during 2022-2030: (1) current-BI (status quo), (2) the effective-training standard-BI, (3) the current-BI plus the village health volunteers (VHV) mobilization, and (4) the effective-training BI plus VHV mobilization.MethodsBy interviewing five public health officers, nine healthcare professionals aiding these services, and fifteen BI service experts, we explored the status quo situation of the Thai smoking cessation service system, including main activities, their quantity assumptions, and activities' unit prices needed to operate the current cessation service system. Then, we modeled additional activities needed to implement the other three simulated scenarios. We estimated the costs and impacts of implementing these strategies over a nine-year operating horizon (2022-2030), covering 3 years of service system preparation and 6 years of full implementation. The modeled costs of these four strategies included intervention and program costs. The study focused on current smokers age 15 years or older. The assessed impact parameters encompassed smoking prevalence, deaths averted, and healthy life-years gained. An Incremental Cost-Effectiveness Analysis compared the four simulated strategies was employed. Data analysis was performed using the One Health Tool software, which the World Health Organization developed.ResultsThe findings of this investigation reveal that all three intervention strategies exhibited cost-effectiveness compared to the prevailing status quo. Among these strategies, Strategy 2, enhancing BI service quality, emerged as the most efficient and efficacious option. Therefore, the expansion of quality services should be synergistically aligned with augmented training, service delivery optimization, and managerial enhancements.ConclusionThis approach is particularly poised to enhance accessibility to and the efficacy of smoking cessation interventions across Thailand.

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Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment.

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Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment.

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