Nadine Berndt1,2, Catherine Bolman3, Lilian Lechner3, Wendy Max4, Aart Mudde3, Hein de Vries5, Silvia Evers6,7. 1. Faculty of Psychology and Educational Sciences, Open University of the Netherlands, POB 2960, 6401 DL, Heerlen, The Netherlands. nadine.berndt@igss.etat.lu. 2. Cellule d'expertise médicale, Inspection générale de la sécurité sociale, Le Gouvernement du Grand-Duché de Luxembourg, POB 1308, 1013, Luxembourg, Luxembourg. nadine.berndt@igss.etat.lu. 3. Faculty of Psychology and Educational Sciences, Open University of the Netherlands, POB 2960, 6401 DL, Heerlen, The Netherlands. 4. Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, CA, 94118, USA. 5. Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands. 6. Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands. 7. Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, POB 725, 3500 AS, Utrecht, The Netherlands.
Abstract
OBJECTIVE: This study examined the cost-effectiveness and cost-utility of two smoking cessation counseling interventions differing in their modality for patients diagnosed with coronary heart disease from a societal perspective. METHODS: In a randomized controlled trial conducted in Dutch hospital wards, cardiac patients who smoked prior to admission were allocated to usual care (n = 245), telephone counseling (n = 223) or face-to-face counseling (n = 157). The counseling interventions lasted for 3 months and were complemented by nicotine patches. Baseline histories were obtained, and interviews took place 6 months after hospitalization to assess self-reported smoking status and quality adjusted life years (QALYs). Incremental cost-effectiveness ratios per quitter and cost-utility ratios per QALY were calculated and presented in acceptability curves. Uncertainty was accounted for by sensitivity analysis. RESULTS: Using continued abstinence as the outcome measure showed that telephone counseling had the highest probability of being cost-effective. Face-to-to-face counseling was also more cost-effective than usual care. No significant improvements and differences in QALYs between the three conditions were found. Varying costs and effect estimations revealed that the results of the primary analyses were robust. CONCLUSIONS: Assuming a willingness-to-pay of €20,000 per abstinent patient, telephone counseling would be a highly cost-effective smoking cessation intervention assisting cardiac patients to quit. However, the lack of consensus concerning the willingness-to-pay per quitter impedes drawing firm conclusions. Moreover, studies with extended follow-up periods are needed to capture late relapses and possible differences in QALYs.
RCT Entities:
OBJECTIVE: This study examined the cost-effectiveness and cost-utility of two smoking cessation counseling interventions differing in their modality for patients diagnosed with coronary heart disease from a societal perspective. METHODS: In a randomized controlled trial conducted in Dutch hospital wards, cardiacpatients who smoked prior to admission were allocated to usual care (n = 245), telephone counseling (n = 223) or face-to-face counseling (n = 157). The counseling interventions lasted for 3 months and were complemented by nicotine patches. Baseline histories were obtained, and interviews took place 6 months after hospitalization to assess self-reported smoking status and quality adjusted life years (QALYs). Incremental cost-effectiveness ratios per quitter and cost-utility ratios per QALY were calculated and presented in acceptability curves. Uncertainty was accounted for by sensitivity analysis. RESULTS: Using continued abstinence as the outcome measure showed that telephone counseling had the highest probability of being cost-effective. Face-to-to-face counseling was also more cost-effective than usual care. No significant improvements and differences in QALYs between the three conditions were found. Varying costs and effect estimations revealed that the results of the primary analyses were robust. CONCLUSIONS: Assuming a willingness-to-pay of €20,000 per abstinent patient, telephone counseling would be a highly cost-effective smoking cessation intervention assisting cardiacpatients to quit. However, the lack of consensus concerning the willingness-to-pay per quitter impedes drawing firm conclusions. Moreover, studies with extended follow-up periods are needed to capture late relapses and possible differences in QALYs.
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