Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD
- 1Institute for Medical Technology Assessment (iMTA), Erasmus University, Rotterdam, The Netherlands
- 2National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- 3Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
- Correspondence to M Hoogendoorn, Institute for Medical Technology Assessment, Erasmus University, P O Box 1738, 3000 DR Rotterdam, The Netherlands;
- Received 20 November 2009
- Accepted 4 May 2010
Background The aim of this study was to estimate the long-term (cost-) effectiveness of smoking cessation interventions for patients with chronic obstructive pulmonary disease (COPD).
Methods A systematic review was performed of randomised controlled trials on smoking cessation interventions in patients with COPD reporting 12-month biochemical validated abstinence rates. The different interventions were grouped into four categories: usual care, minimal counselling, intensive counselling and intensive counselling + pharmacotherapy (‘pharmacotherapy’). For each category the average 12-month continuous abstinence rate and intervention costs were estimated. A dynamic population model for COPD was used to project the long-term (cost-) effectiveness (25 years) of 1-year implementation of the interventions for 50% of the patients with COPD who smoked compared with usual care. Uncertainty and one-way sensitivity analyses were performed for variations in the calculation of the abstinence rates, the type of projection, intervention costs and discount rates.
Results Nine studies were selected. The average 12-month continuous abstinence rates were estimated to be 1.4% for usual care, 2.6% for minimal counselling, 6.0% for intensive counselling and 12.3% for pharmacotherapy. Compared with usual care, the costs per quality-adjusted life year (QALY) gained for minimal counselling, intensive counselling and pharmacotherapy were €16 900, €8200 and €2400, respectively. The results were most sensitive to variations in the estimation of the abstinence rates and discount rates.
Conclusion Compared with usual care, intensive counselling and pharmacotherapy resulted in low costs per QALY gained with ratios comparable to results for smoking cessation in the general population. Compared with intensive counselling, pharmacotherapy was cost saving and dominated the other interventions.
Funding This study was financially supported by the Dutch Government (Ministry of Health).
Competing interests MH has participated in smoking cessation research that is financially supported by the pharmaceutical industry. TF is an employee of the Dutch National Institute for Public Health and the Environment and also works on a project granted by the Dutch National Asthma Foundation to develop a simulation model of COPD. MR-vM participates in smoking cessation research that is financially supported by the pharmaceutical industry and also acts as a consultant on smoking cessation issues. RH has no conflicts of interest.
Provenance and peer review Not commissioned; externally peer reviewed.