Cost-effective primary care-based strategies to improve smoking cessation: more value for money. Export

@article{citeulike:4155456, abstract = {BACKGROUND: Evidence from cost-effective smoking cessation programs is scarce. This study determined the cost-effectiveness of 3 smoking cessation strategies as provided by general practitioners (GPs) in Germany. METHODS: In a cluster-randomized smoking cessation trial, rates and intervention costs for 577 smoking patients of 82 GPs were followed up for 12 months. Three smoking cessation treatments were tested: (1) GP training plus GP remuneration for each abstinent patient, (2) GP training plus cost-free nicotine replacement medication and/or bupropion hydrochloride for the patient, and (3) a combination of both strategies. Smoking abstinence at 12 months was the primary outcome used to calculate incremental cost-effectiveness ratios and net monetary benefits. RESULTS: Intervention 1 was not effective compared with treatment as usual (TAU). Interventions 2 and 3 each proved to be cost-effective compared separately with TAU. When applying a 95\% level of certainty of cost-effectiveness against TAU, euro 9.80 or euro 6.96, respectively, had to be paid for each additional 1\% of patients abstinent at 12 months (maximum willingness to pay). That means that in intervention 2, euro 92.12 per patient in the program must be invested to gain 1 additional quitter (as opposed to euro 39.10 paid per patient during the trial). In intervention 2, the cost was euro 82.82, as opposed to euro 50.04. Neither of these 2 cost-effective treatments proved to be superior to the other. The cost-effectiveness of both treatments was stable against TAU in sensitivity analyses. (The exchange rate from October 1, 2003, was used; euro1 = \$1.17.) CONCLUSIONS: Both treatments have a high potential to reduce smoking-related morbidity at a low cost. It is highly recommended that they be implemented as a routine service offered by GPs because in many countries, health insurance plans currently do not fund nicotine replacement therapy.}, author = {Salize, H. J. and Merkel, S. and Reinhard, I. and Twardella, D. and Mann, K. and Brenner, H.}, citeulike-article-id = {4155456}, citeulike-linkout-0 = {http://dx.doi.org/10.1001/archinternmed.2008.556}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/19204212}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=19204212}, doi = {10.1001/archinternmed.2008.556}, issn = {1538-3679}, journal = {Archives of internal medicine}, keywords = {morestellar, smoking}, month = {February}, number = {3}, posted-at = {2009-03-11 22:16:41}, priority = {2}, title = {Cost-effective primary care-based strategies to improve smoking cessation: more value for money.}, url = {http://dx.doi.org/10.1001/archinternmed.2008.556}, volume = {169}, year = {2009} }

TY - JOUR ID - citeulike:4155456 L3 - citeulike-article-id:4155456 N2 - BACKGROUND: Evidence from cost-effective smoking cessation programs is scarce. This study determined the cost-effectiveness of 3 smoking cessation strategies as provided by general practitioners (GPs) in Germany. METHODS: In a cluster-randomized smoking cessation trial, rates and intervention costs for 577 smoking patients of 82 GPs were followed up for 12 months. Three smoking cessation treatments were tested: (1) GP training plus GP remuneration for each abstinent patient, (2) GP training plus cost-free nicotine replacement medication and/or bupropion hydrochloride for the patient, and (3) a combination of both strategies. Smoking abstinence at 12 months was the primary outcome used to calculate incremental cost-effectiveness ratios and net monetary benefits. RESULTS: Intervention 1 was not effective compared with treatment as usual (TAU). Interventions 2 and 3 each proved to be cost-effective compared separately with TAU. When applying a 95% level of certainty of cost-effectiveness against TAU, euro 9.80 or euro 6.96, respectively, had to be paid for each additional 1% of patients abstinent at 12 months (maximum willingness to pay). That means that in intervention 2, euro 92.12 per patient in the program must be invested to gain 1 additional quitter (as opposed to euro 39.10 paid per patient during the trial). In intervention 2, the cost was euro 82.82, as opposed to euro 50.04. Neither of these 2 cost-effective treatments proved to be superior to the other. The cost-effectiveness of both treatments was stable against TAU in sensitivity analyses. (The exchange rate from October 1, 2003, was used; euro1 = $1.17.) CONCLUSIONS: Both treatments have a high potential to reduce smoking-related morbidity at a low cost. It is highly recommended that they be implemented as a routine service offered by GPs because in many countries, health insurance plans currently do not fund nicotine replacement therapy. IS - 3 JF - Archives of internal medicine SN - 1538-3679 TI - Cost-effective primary care-based strategies to improve smoking cessation: more value for money. VL - 169 KW - morestellar KW - smoking AU - Salize, HJ AU - Merkel, S AU - Reinhard, I AU - Twardella, D AU - Mann, K AU - Brenner, H PY - 2009/02/09/ UR - http://dx.doi.org/10.1001/archinternmed.2008.556 ER -