Cost-Effectiveness of In-Hospital Motivational Smoking Cessation Counseling and Proactive Referral to Primary Care Follow-up
Author(s)
Ingrid Engebretsen, PhD Candidate1, Karin Pleym, PhD Candidate2, Ivar Sonbo Kristiansen, MD, PhD3, Henrik Støvring, Professor4, John Munkhaugen, Professor2.
1Oslo Economics, Oslo, Norway, 2Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway, 3University of Oslo, Oslo, Norway, 4Department of Biomedicine, Aarhus University, Aarhus, Denmark.
1Oslo Economics, Oslo, Norway, 2Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway, 3University of Oslo, Oslo, Norway, 4Department of Biomedicine, Aarhus University, Aarhus, Denmark.
OBJECTIVES: To evaluate the cost-effectiveness of a nurse-led, in-hospital smoking cessation intervention with proactive referral to primary care follow-up offering free cessation drugs among patients with atherosclerotic cardiovascular disease (ASCVD).
METHODS: Data was obtained from an intervention designed as a prospective, randomised, open-label trial with blinded endpoint evaluation. Primary outcome was the net monetary benefit, measured by total per patient costs and total per patient life-years gained. Total costs included the cost of the intervention, hospital-related healthcare costs over a 16-month follow-up, and predicted remaining life-time costs. Hospital-related costs included all in- and outpatient contacts, monetized using Diagnosis-Related Group (DRG) points. Total life-years gained included life-years gained during the 16-month follow-up period and predicted future life-years. Predicted remaining life-years were calculated via a survival model based on age-, sex-, and ASCVD-adjusted mortality rates. Future life-years and costs were discounted by the conventional 4% rate. A willingness-to-pay threshold of €38,346 per life-year was used for calculating net monetary benefit (NMB).
RESULTS: The cost of the intervention was €97.0 in the intervention group, and €16.2 in the control group. The cost difference was mainly driven by the additional components of the nurse-led counselling and follow-up procedure. Over the 16-month follow-up, the intervention group experienced a reduction in hospital-related per-patient costs by €4,859 (95% CI: -€11,232 to €1,514) relative to the control group. The intervention group also yielded an increase of 0.048 undiscounted life-years (95% CI: -0.013 to 0.110). Estimated difference was €5,091 (95% CI: -€19,529-€26,488) in remaining life-time costs and 1.05 (95% CI: -0.71-3.31) in remaining life-years. The estimated NMB was €37,475 (95% CI: -€15,868-€107,797), with a 90.5% probability that the intervention is cost-effective.
CONCLUSIONS: An in-hospital, motivational smoking cessation intervention with proactive referral is highly likely to be cost-effective for patients with ASCVD from a hospital perspective.
METHODS: Data was obtained from an intervention designed as a prospective, randomised, open-label trial with blinded endpoint evaluation. Primary outcome was the net monetary benefit, measured by total per patient costs and total per patient life-years gained. Total costs included the cost of the intervention, hospital-related healthcare costs over a 16-month follow-up, and predicted remaining life-time costs. Hospital-related costs included all in- and outpatient contacts, monetized using Diagnosis-Related Group (DRG) points. Total life-years gained included life-years gained during the 16-month follow-up period and predicted future life-years. Predicted remaining life-years were calculated via a survival model based on age-, sex-, and ASCVD-adjusted mortality rates. Future life-years and costs were discounted by the conventional 4% rate. A willingness-to-pay threshold of €38,346 per life-year was used for calculating net monetary benefit (NMB).
RESULTS: The cost of the intervention was €97.0 in the intervention group, and €16.2 in the control group. The cost difference was mainly driven by the additional components of the nurse-led counselling and follow-up procedure. Over the 16-month follow-up, the intervention group experienced a reduction in hospital-related per-patient costs by €4,859 (95% CI: -€11,232 to €1,514) relative to the control group. The intervention group also yielded an increase of 0.048 undiscounted life-years (95% CI: -0.013 to 0.110). Estimated difference was €5,091 (95% CI: -€19,529-€26,488) in remaining life-time costs and 1.05 (95% CI: -0.71-3.31) in remaining life-years. The estimated NMB was €37,475 (95% CI: -€15,868-€107,797), with a 90.5% probability that the intervention is cost-effective.
CONCLUSIONS: An in-hospital, motivational smoking cessation intervention with proactive referral is highly likely to be cost-effective for patients with ASCVD from a hospital perspective.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE257
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)