Cost-effectiveness of smoking cessation treatment initiated during psychiatric hospitalization: analysis from a randomized, controlled trial

Author(s): Barnett, PG; Wong, W; Jeffers, A; Hall, SM; Prochaska, JJ | Abstract: © Copyright 2015 Physicians Postgraduate Press, Inc. Objective: We examined the cost-effectiveness of smoking cessation treatment for psychiatric inpatients. Method: Smokers, regardless of intention to quit, were recruited during psychiatric hospitalization and randomized to receive stage-based smoking cessation services or usual aftercare. Smoking cessation services, quality of life, and biochemically verified abstinence from cigarettes were assessed during 18 months of follow-up. A Markov model of cost-effectiveness over a lifetime horizon was constructed using trial findings and parameters obtained in a review of the literature on quit and relapse rates and the effect of smoking on health care cost, quality of life, and mortality. Results: Among 223 smokers randomized between 2006 and 2008, the mean cost of smoking cessation services was $189 in the experimental treatment group and $37 in the usual care condition (P l .001). At the end of followup, 18.75% of the experimental group was abstinent from cigarettes, compared to 6.80% abstinence in the usual care group (P l .05). The model projected that the intervention added $43 in lifetime cost and generated 0.101 additional quality-adjusted life-years (QALYs), an incremental costeffectiveness ratio of $428 per QALY. Probabilistic sensitivity analysis found the experimental intervention was costeffective against the acceptance criteria of $50,000/QALY in 99.0% of the replicates. Conclusions: A cessation intervention for smokers identified in psychiatric hospitalization did not result in higher mental health care costs in the short-run and was highly costeffective over the long-term. The stage-based intervention was a feasible and cost-effective way of addressing the high smoking prevalence in persons with serious mental illness.