C A Jiménez-Ruiz1, V Martín2, X Alsina-Restoy3, J I de Granda-Orive4, E de Higes-Martínez5, M García-Rueda6, M Genovés-Crespo7, C López-García8, J J Lorza-Blasco9, F L Márquez10, Á Ramos-Pinedo5, J A Riesco-Miranda11, J Signes-Costa12, S Solano-Reina13, P Vaquero-Lozano13, J Rejas14. 1. Specialized Tobacco Unit, Hospital Clínico San Carlos, Madrid, Spain. 2. Department of Economics, University Carlos III, Madrid, Spain. 3. Department of Respiratory Medicine, Hospital Clínic, Barcelona, Spain. 4. Department of Respiratory Medicine, Hospital 12 de Octubre, Madrid, Spain. 5. Department of Respiratory Medicine, Hospital Fundación Alcorcón, Alcorcón, Spain. 6. Department of Respiratory Medicine, Hospital Regional Universitario de Málaga, Málaga, Spain. 7. Department of Thoracic Surgery, Complejo Hospitalario Universitario de Albacete, Albacete, Spain. 8. Department of Thoracic Surgery, Badajoz, Spain. 9. Department of Respiratory Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain. 10. Department of Respiratory Medicine, Hospital Infanta Cristina, Badajoz, Spain. 11. Department of Respiratory Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain. 12. Department of Respiratory Medicine, Hospital Clínico, Valencia, Spain. 13. Department of Respiratory Medicine, Hospital Gregorio Marañón, Madrid, Spain. 14. Department of Health Economics and Outcomes Research, Pfizer SLU, Alcobendas, Spain.
Abstract
BACKGROUND: Smoking at the time of surgery is associated with postoperative complications. Quitting smoking before surgery is linked to fewer complications during the hospital stay. This work analysed whether a smoking cessation intervention before surgery is economically worthwhile when funded by the National Health System (NHS) in Spain. METHODS: The economic analysis considered costs and benefits of the intervention to the NHS for the year 2016. The population who would benefit comprised adult smokers who were ready to quit and for whom surgery requiring admission to hospital was planned. The intervention, a combination of medical counselling and use of a smoking cessation drug which should occur 12 weeks before surgery, considered one attempt only to quit smoking. Benefits were costs avoided by averting postoperative complications if cessation was successful. The analysis compared the net economic outcome (benefit minus cost of intervention) and the return on investment, for intervention funded by the NHS versus the current situation without funding. RESULTS: Smoking cessation increased by 21·7 per cent with funding; the rate was 32·5 per cent when funded versus 10·7 per cent without funding, producing 9611 extra quitters. The cost per averted smoker was €1753 with a benefit of €503, achieving a net economic benefit of €4·8 million per year. Given the annual cost of the intervention (€17·4 million, of which €5·6 million (32·5 per cent) represents drugs), the return on investment was 28·7 per cent annually, equivalent to €1·29 per €1 of investment. CONCLUSION: From the perspective of the Spanish NHS, the benefit of funding smoking cessation before surgery, in terms of healthcare cost savings, appears to greatly outweigh the costs.
BACKGROUND: Smoking at the time of surgery is associated with postoperative complications. Quitting smoking before surgery is linked to fewer complications during the hospital stay. This work analysed whether a smoking cessation intervention before surgery is economically worthwhile when funded by the National Health System (NHS) in Spain. METHODS: The economic analysis considered costs and benefits of the intervention to the NHS for the year 2016. The population who would benefit comprised adult smokers who were ready to quit and for whom surgery requiring admission to hospital was planned. The intervention, a combination of medical counselling and use of a smoking cessation drug which should occur 12 weeks before surgery, considered one attempt only to quit smoking. Benefits were costs avoided by averting postoperative complications if cessation was successful. The analysis compared the net economic outcome (benefit minus cost of intervention) and the return on investment, for intervention funded by the NHS versus the current situation without funding. RESULTS: Smoking cessation increased by 21·7 per cent with funding; the rate was 32·5 per cent when funded versus 10·7 per cent without funding, producing 9611 extra quitters. The cost per averted smoker was €1753 with a benefit of €503, achieving a net economic benefit of €4·8 million per year. Given the annual cost of the intervention (€17·4 million, of which €5·6 million (32·5 per cent) represents drugs), the return on investment was 28·7 per cent annually, equivalent to €1·29 per €1 of investment. CONCLUSION: From the perspective of the Spanish NHS, the benefit of funding smoking cessation before surgery, in terms of healthcare cost savings, appears to greatly outweigh the costs.