Scott B Cantor1, Ashish A Deshmukh2, Nancy Stancic Luca3, Graciela M Nogueras-González4, Tanya Rajan2, Alexander V Prokhorov5. 1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: sbcantor@mdanderson.org. 2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Office of Research, Texas Woman's University, Houston, TX, USA. 4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Abstract
BACKGROUND: Although smoking-cessation interventions typically focus directly on patients, this paper conducts an economic evaluation of a novel smoking-cessation intervention focused on training physicians and/or pharmacists to use counseling techniques that would decrease smoking rates at a reasonable cost. PURPOSE: To evaluate the cost-effectiveness of interventions that train physicians and/or pharmacists to counsel their patients on smoking-cessation techniques. METHODS: Using decision-analytic modeling, we compared four strategies for smoking-cessation counseling education: training only physicians, training only pharmacists, training both physicians and pharmacists (synergy strategy), and training neither physicians nor pharmacists (i.e., no specialized training, which is the usual practice). Short-term outcomes were based on results from a clinical trial conducted in 16 communities across the Houston area; long-term outcomes were calculated from epidemiological data. Short-term outcomes were measured using the cost per quit, and long-term outcomes were measured using the cost per quality-adjusted life-year (QALY). Cost data were taken from institutional sources; both costs and QALYs were discounted at 3%. RESULTS: Training both physicians and pharmacists added 0.09 QALY for 45-year-old men. However, for 45-year-old women, the discounted quality-adjusted life expectancy only increased by 0.01 QALY when comparing the synergy strategy to no intervention. The incremental cost-effectiveness ratio (ICER) of the synergy strategy with respect to the non-intervention strategy was US$868/QALY for 45-year-old men and US$8953/QALY for 45-year-old women. The results were highly sensitive to the quit rates and community size. CONCLUSION: Synergistic educational training for physicians and pharmacists could be a cost-effective method for smoking cessation in the community. Published by Elsevier Ltd.
BACKGROUND: Although smoking-cessation interventions typically focus directly on patients, this paper conducts an economic evaluation of a novel smoking-cessation intervention focused on training physicians and/or pharmacists to use counseling techniques that would decrease smoking rates at a reasonable cost. PURPOSE: To evaluate the cost-effectiveness of interventions that train physicians and/or pharmacists to counsel their patients on smoking-cessation techniques. METHODS: Using decision-analytic modeling, we compared four strategies for smoking-cessation counseling education: training only physicians, training only pharmacists, training both physicians and pharmacists (synergy strategy), and training neither physicians nor pharmacists (i.e., no specialized training, which is the usual practice). Short-term outcomes were based on results from a clinical trial conducted in 16 communities across the Houston area; long-term outcomes were calculated from epidemiological data. Short-term outcomes were measured using the cost per quit, and long-term outcomes were measured using the cost per quality-adjusted life-year (QALY). Cost data were taken from institutional sources; both costs and QALYs were discounted at 3%. RESULTS: Training both physicians and pharmacists added 0.09 QALY for 45-year-old men. However, for 45-year-old women, the discounted quality-adjusted life expectancy only increased by 0.01 QALY when comparing the synergy strategy to no intervention. The incremental cost-effectiveness ratio (ICER) of the synergy strategy with respect to the non-intervention strategy was US$868/QALY for 45-year-old men and US$8953/QALY for 45-year-old women. The results were highly sensitive to the quit rates and community size. CONCLUSION: Synergistic educational training for physicians and pharmacists could be a cost-effective method for smoking cessation in the community. Published by Elsevier Ltd.
Entities:
Keywords:
Costs and cost analysis; Medical decision making; Nicotine; Smoking cessation
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