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Smoking cessation interventions are very cost-effective in producing population health gain, compared with other preventive and medical interventions in high-income countries.

Smoking cessation interventions have been shown to be highly cost-effective (Cromwell et al., 1997; Parrott et al., 1998; Stapleton et al., 1999; Tobacco Free Initiative - WHO, 2009). Parrott and colleagues estimated that the cost per discounted year saved from a societal perspective ranged from £212 (brief advice) to £873 (an integrated smoking cessation service involving brief advice, self-help, NRT and specialist cessation service). More recently, personalized smoking cessation advice and support by mobile phone message has been found to be beneficial for health and cost saving to the UK NHS (Guerriero et al., 2013).

These figures compare very favorably with other health care procedures. An international review found the median societal cost of over 310 medical interventions to be £17,000 per life year gained (Tengs et al., 1995). In the UK, the cost-effectiveness of statins was estimated to be £5,400 - £13,300 per life year gained yet expenditure on statins far exceeded (about 12 times greater) expenditure on smoking cessation (McNeill & Bates, 2000). Smoking cessation would also impact on the cost of other therapies. Taking the example of statins again (in the UK), Muir and colleagues (1999) estimated that if smokers who were assigned to statins at screening stopped smoking, the cost of statin therapy would fall by around £315m from an estimated £357m.

In England, the cost-effectiveness of smoking cessation services falls well below the informal benchmark (£30,000 per QALY) used for assessing the cost-effectiveness of interventions in the National Health Service (Raftery, 2001). The US-based Partnership for Prevention developed a rank-ordered list of clinical preventive services, among which tobacco cessation scored a perfect 10/10 (along with aspirin chemoprophylaxis and childhood immunizations) for both cost effectiveness and clinical preventive benefit.

In the U.S.,  Fiore and colleagues (2008) estimate the cost per life-year saved of tobacco dependence treatment to be $3,539.  These estimates compare favorably with other health interventions in the U.S. like statins (which costs $50,000 per life-year saved), and diabetes treatment ($34,000 per life-year saved) (Krumholz et al., 2002).

It is the recommendation of the USPHS Clinical Practice Guidelines that “The tobacco dependence treatments shown to be effective in this Guideline (both counseling and medication) are highly cost-effective relative to other reimbursed treatments and should be provided to all smokers.” (Fiore et al., 2008).

Cromwell J, Bartosch WJ, Fiore MC, et al. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research. JAMA. 1997; 278: 1759-1766.

Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

Guerriero C, Cairns J, Roberts I, Rodgers A, Whittaker R, Free C. The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop. Eur J Health Econ. 2013; 14: 789-797.

Krumholz HM, Weintraub WS, Bradford WD, Heidenreich PA, Mark DB, Paltiel AD
. Task force #2--the cost of prevention: can we afford it? Can we afford not to do it? 33rd Bethesda Conference. J Am Coll Cardiol. 2002; 40(4): 603-615.

McNeill A, Bates C. Smoking cessation in primary care…how to spend NHS money much more effectively. London: ASH. 2000.

Muir J, Fuller A, Lancaster T. Applying the Sheffield tables to data from general practice. Br J Gen Pract. 1999; 49: 218-219.

Parrott S, Godfrey C, Raw M, West R, McNeill A. Guidance for commissioners on the cost effectiveness of smoking cessation interventions. Thorax. 1998; 53: S1-S38.

Raftery J. NICE: faster access to modern treatments? Analysis of guidance on health technologies. BMJ. 2001; 323: 1300-1303.

Stapleton JA, Lowin A, Russell MAH. Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness. Lancet. 1999; 354: 210-215.

Tengs TO, Adams ME, Pliskin JS, Safran DG, Siegel JE, Weinstein MC, Graham JD. Five hundred life saving interventions and their cost effectiveness. Risk Analysis. 1995; 15: 369-390.

US Partnership for Prevention. Rank-ordered list of clinical preventive services.

World Health Organisation. Two forms of nicotine replacement therapy chosen as WHO "Essential Medicines". 17th Expert Committee on the Selection and Use of Essential Medicines. 2009. logo
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