Cost-effectiveness of in-hospital motivational smoking cessation counselling and proactive referral to community-based follow-up.

BACKGROUND AND

aimIn a randomised open-label trial among hospitalised patients with atherosclerotic vascular disease, motivational smoking cessation counselling with proactive referral to community-based follow-up was more effective than brief cessation advice and written information, with 6-month continuous abstinence rates of 49.5% vs. 24.5%. This study aimed to estimate the cost-effectiveness of this intervention compared with brief cessation advice.

designEconomic evaluation alongside a multicentre, randomised open-label, blinded-endpoint trial with 1:1 randomisation.

settingThree secondary care hospitals in Norway. Recruitment took place from November 2021 to October 2023.

participantsHospitalised patients aged 18 years or older with established atherosclerotic vascular disease who reported smoking at least one cigarette daily before admission were eligible for participation, regardless of whether admission was planned or unplanned. A total of 221 patients were randomised. One participant withdrew informed consent and was excluded from all analyses, leaving 220 participants in the economic evaluation. The cohort comprised 40% women and the mean age was 65.2 years. MEASUREMENTS: Intervention costs included staff training, materials and personnel time. Hospital costs during the 16-month follow-up were estimated using Diagnosis-Related Group cost weights. Survival beyond follow-up was extrapolated using national mortality data adjusted for age, sex and atherosclerotic vascular disease. Lifetime costs were estimated using mean costs from the final six months of follow-up. The primary economic outcome was net monetary benefit (NMB), calculated at a willingness-to-pay threshold of €38 346 per life-year gained. The incremental cost-effectiveness ratio was also estimated. Future costs and life-years were discounted at 4%. Uncertainty estimates (UE) were obtained using bootstrapping.

findingsDuring the 16-month follow-up, five patients (4.6%) died in the intervention group and nine (8.1%) in the control group. Discounted life expectancy from baseline was 13.54 years in the intervention group and 12.47 years in the control group, corresponding to an incremental gain of 1.06 life-years (95% UE = -0.72 to 3.31). The incremental discounted lifetime cost was €3280 per patient (95% UE = -€19 457 to €26 436), resulting in an incremental cost-effectiveness ratio of €3094 per life-year gained. At a willingness-to-pay threshold of €38 346 per life-year gained, the NMB was €37 475 (95% UE = -€15 868 to €107 797) and the probability of the intervention being cost-effective was 90.5%.

conclusionMotivational smoking cessation counselling delivered during hospitalisation with proactive referral to community-based follow-up had a high probability of being cost-effective from a hospital perspective for patients with atherosclerotic vascular disease.