A direct method and ICER tables for the estimation of the cost-effectiveness of smoking cessation interventions in general populations: application to a new cytisine trial and other examples
Abstract
INTRODUCTION: The popularity of smoking cost-effectiveness (CE) analysis has grown rapidly. Differences in models and inputs mean results may not be comparable, and researchers may have to take them on trust because the methods are beyond their expertise and not always transparent. We describe a direct method and tables of results for researchers without specialist knowledge. METHODS: We estimate the health benefit to an individual attributed to an intervention and compute tables of incremental cost-effectiveness ratios (ICERs) for interventions with varying incremental intervention effects and costs. Estimates of life years gained come from the longest epidemiological study. After discounting, adjustments are made for future cessation and relapse. The method is described in simple steps, and conservative inputs are used throughout. RESULTS: To look up an ICER, the user needs only to know the cost of the intervention per smoker and the effect as measured by the percentage of ex-smokers attributable to the intervention at either 6- or 12-month follow-up. Reanalysis of authoritative reports indicates that these ICERs are comparable to those from decision-analytic simulation models. CONCLUSIONS: Researchers can now obtain immediate estimates of the CE of interventions in general populations. The method is easily programmed in a spreadsheet. ICERs are from the payer perspective and exclude offset and societal costs. Interventions in subpopulations will require inputs specific to those populations. Readers who wish to include an adjustment for quality of life can easily do so. The tables might promote a standard approach, with interventions compared on a consistent and transparent basis.
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The best estimates of the relapse rate to smoking after 1 year are 35%.
“The best estimates of the relapse rate to smoking after 1 year are 35%.88”
From Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study (2015) · cites this paper as [88]
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- Authors
- Stapleton, J. A., & West, R.
- Affiliations
- Cancer Research UK (GB)
- ORCID
- West, R.
- Venue
- Nicotine & Tobacco Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-01-09
- Volume
- 14
- Issue
- 4
- Pages
- 463-471
- ISSN
- 1462-2203 (ISSN-L)
- 1469-994X
- OpenAlex
- W2327961501
- Cited by
- 62
- References
- 17
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 5 · 2023: 4 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 7 · 2016: 6 · 2015: 6 · 2014: 5 · 2013: 9
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Cancer Research UK (14135)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- smoking cessation interventions, cost-effectiveness, incremental cost-effectiveness ratio, cytisine, life-years gained, relapse, former smokers, general population
- MeSH terms
- Quinolizidine Alkaloids, Adult, Aged, Aged, 80 and over, Alkaloids, Azocines, Cost-Benefit Analysis, Female, Health Promotion, Humans, Life Expectancy, Male, Middle Aged, Nicotine, Quinolizines, Smoking, Models, Statistical, Life Tables, Smoking Cessation, Quality-Adjusted Life Years
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