Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses. Smoking cessation may not improve quality of life in atherosclerotic patients. Identifying effective behavioural components of Intervention and Comparison group support provided in SMOKing cEssation (IC-SMOKE) interventions: a systematic review protocol Cost-effectiveness of a hospital-based smoking cessation intervention. Comparison of the cost-effectiveness of a high- and a low-intensity smoking cessation intervention in Sweden: a randomized trial. Community pharmacy interventions for public health priorities: protocol for a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions Cost Effectiveness of Varenicline in Belgium, Compared with Bupropion, Nicotine Replacement Therapy, Brief Counselling and Unaided Smoking Cessation Are Electronic Cigarettes an Effective Aid to Smoking Cessation or Reduction Among Vulnerable Groups? A Systematic Review of Quantitative and Qualitative Evidence. Effectiveness of a Combined Prenatal and Postpartum Smoking Cessation Program A new model of integrated primary-secondary care for complex diabetes in the community: study protocol for a randomised controlled trial Cost-effectiveness of varenicline compared with nicotine patches for smoking cessation--results from four European countries.
Tobacco smoking is a risk factor for cancer , respiratory disease , and cardiovascular disease . It is estimated that 19 % of Canadians ( approximately 5.2 million ) aged 15 years and older were smokers in 2007.1 Each year , approximately 45,000 Canadians die from smoking.2 Significantly , one-third of Canadian smokers aged 15 years or older express an intention to quit in the next 30 days.3 Nicotine , the addictive chemical component of tobacco products that attracts smokers , has consequences for personal and community health . Smoking is an addiction . Although many smokers report that they quit unaided , most smokers who try to quit without smoking cessation aids are unsuccessful in the long term . In the US and UK , 70 % of smokers intend to quit every year , 45 % try to quit , and less than 5 % are successful.4,5 The rate of relapse is high among smokers who quit without treatment . The proportion of smokers who can achieve abstinence for at least one week is 25 % to 51 % , 10 % to 20 % for those able to do it for at least three months , and only 3 % to 5 % for those able to abstain for six months.6 There are many prescribed pharmacotherapies for smoking cessation , including nicotine replacement products , bupropion , and varenicline . Smoking cessation programs often combine drug treatment and behavioural support ( such as psychological interventions , telephone support , and self-help ) . Objective The objective of the report was to : Compare the pharmacological agents ( drug-based smoking cessation aids ) to determine which of these works best ( clinical effectiveness ) at six months and 12 months after patients attempt to quit smoking . Perform an economic analysis to determine which smoking cessation therapy was the most cost-effective for patients , drug plans , and the Canadian health care system . Methods To compare pharmacological agents with or without behavioural support programs for  smoking cessation  in adults , a systematic review with meta-analyses and an economic evaluation were carried out . A budget impact analysis and an examination of current public funding and planning issues were also performed . For the clinical review , a total of 155 articles ( from August 1982 to June 2009 ) describing 143 trials were selected for inclusion in the clinical analyses . To meet the inclusion criteria , r and omized controlled trials ( RCTs ) must have reported biochemically vali date d measures of smoking abstinence from the study start date or from the target quit date of at least six months . Analyses were conducted using a Bayesian r and om effects model for mixed treatment comparisons meta- analysis . Continuous abstinence rates ( patients have not smoked at all since quitting ) and point prevalence abstinence rates ( patients have not smoked in the past seven days ) were analyzed separately . For the economic analysis , a decision-analytic model was constructed to assess the cost-effectiveness ( cost per additional quitter and cost per life-year gained ; cost per quality -adjusted life-year [ QALY ] gained ) of nicotine replacement therapy ( NRT ) , bupropion , and varenicline compared with no pharmacologic treatment , from the perspective of a publicly funded health care system . For the base case , the general population ( stratified by age and gender ) motivated to quit smoking was considered . Treatment strategies included one-time cessation interventions of NRT , bupropion , varenicline , and no pharmacologic treatment ; it was assumed that all patients received the same level of behavioural support . Budget impact analyses were conducted by comparing current utilization patterns of NRT , bupropion , and varenicline  , with alternative scenarios reflecting the prescription patterns of these therapies The benefits of smoking cessation on patients ' medical conditions are well documented . Cardiovascular patients who quit smoking significantly reduce their risk of a new event compared with those who continue smoking . Several studies have found that smoking is related to poor quality of life ( QoL ) . In cardiovascular patients , however , less attention has been given to the effect of smoking cessation on patients ' QoL. The present study examined the extent to which smoking cessation leads to changes in QoL in these patients within the first year of follow-up . Data were collected in the context of a r and omized clinical trial . Smoking out patients ( N = 346 ) with atherosclerotic disease were included and received medical treatment . They were r and omized to receive either nicotine replacement therapy ( NRT ) or NRT plus a behavioral intervention meant to promote smoking cessation . At baseline , sociodemographic and clinical characteristics were established . Generic and disease-specific QoL as well as smoking status were assessed at baseline and with three follow-up measurements . Multilevel modeling showed that generic and disease-specific QoL in atherosclerotic patients improved significantly within the first year of follow-up . No main differences were found between quitters and smokers in terms of improvement in QoL. In fact , some subgroups reported a poorer QoL after smoking cessation : More highly educated patients reported lower general QoL ( p < .05 ) , and patients suffering from coronary artery disease who had a low level of education ( p < .01 ) and patients suffering from peripheral arterial disease who had low nicotine dependency ( p < .01 ) reported lower disease-specific QoL.  Atherosclerotic patients '  QoL improved significantly but was not enhanced by smoking cessation activities Background Systematic review s of behaviour change interventions for  smoking cessation  vary in scope , quality , and applicability . The current review aims to generate more accurate and useful findings by ( 1 ) a detailed analysis of intervention elements that change behaviour ( i.e. behaviour change techniques ( BCTs ) ) and potential moderators of behaviour change ( i.e. other intervention and sample characteristics ) and ( 2 ) assessing and controlling for variability in support provided to comparison groups in smoking cessation trials . Methods A systematic review will be conducted of r and omized controlled trials of behaviour change interventions for smoking cessation in adults ( with or without pharmacological support ) , with a minimum follow-up of 6 months , published after 1995 . Eligible articles will be identified through the Cochrane Tobacco Addiction Group Specialized Register . Study authors will be asked for detailed descriptions of smoking cessation support provided to intervention and comparison groups . All data will be independently coded by two research ers . The BCT taxonomy v1 ( tailored to smoking cessation interventions ) and template for intervention description and replication criteria will be used to code intervention characteristics . Data collection will further include sample and trial characteristics and outcome data ( smoking cessation rates ) . Multilevel mixed-effects meta-regression models will be used to examine which BCTs and /or BCT clusters delivered to intervention and comparison groups explain smoking cessation rates in treatment arms ( and effect sizes ) and what key moderators of behaviour change are . Predicted effect sizes of each intervention will be computed assuming all interventions are compared against comparison groups receiving the same levels of behavioural support ( i.e. low , medium , and high levels ) . Multi-disciplinary advisory board members ( policymakers , health care providers , and (ex-)smokers ) will provide strategic input throughout the project to ensure the review ’s applicability to policy and practice . Discussion By capturing BCTs in intervention and comparison groups , this systematic review will provide more accurate estimates of the effectiveness of smoking cessation interventions , the most promising BCTs and /or BCT clusters associated with smoking cessation rates in intervention and comparison arms , and important moderators of behaviour change . The results could set new st and ards for conducting meta-analyses of behaviour change interventions and improve research , service delivery , and training in the area of smoking cessation . Systematic review registration PROSPERO OBJECTIVES This study evaluated the cost-effectiveness of a  smoking cessation and relapse-prevention program  for hospitalized adult smokers from the perspective of an implementing hospital . It is an economic analysis of a two-group , controlled clinical trial in two acute care hospitals owned by a large group-model health maintenance organization . The intervention included a 20-minute bedside counseling session with an experienced health counselor , a 12-minute video , self-help material s , and one or two follow-up calls . METHODS Outcome measures were incremental cost ( above usual care ) per quit attributable to the intervention and incremental cost per discounted life-year saved attributable to the intervention . RESULTS Cost of the research intervention was $ 159 per smoker , and incremental cost per incremental quit was $ 3,697 . Incremental cost per incremental discounted life-year saved ranged between $ 1,691 and $ 7,444 , much less than most other routine medical procedures . Replication scenarios suggest that , with realistic implementation assumptions , total intervention costs would decline significantly and incremental cost per incremental discounted life-year saved would be reduced by more than 90 % , to approximately $ 380 . CONCLUSIONS Providing brief smoking cessation advice to hospitalized smokers is relatively inexpensive , cost-effective , and should become a part of the st and ard of inpatient care OBJECTIVE To assess the relative cost-effectiveness of a high-intensity treatment ( HIT ) and a low-intensity treatment ( LIT ) for smoking cessation . METHODS The societal and health care perspective economic evaluation was based on the reported number of quitters at 12-month follow-up ( point prevalence ) from a r and omized controlled trial of 2 smoking cessation programs in Sweden . Future disease-related costs ( in Swedish kronor [ SEK ] 2004 ; SEK7.35 = USD1 ) and health effects ( in quality -adjusted life-years [ QALYs ] ) were estimated via a Markov model comprising lung cancer , chronic obstructive pulmonary disease , and cardiovascular disease including stroke with costs and QALYs discounted 3 % annually . RESULTS HIT was more effective than LIT ( 23 % vs. 16 % quitters ) , but at a considerably higher intervention cost : SEK26,100 versus 9,100 per quitter . The model-estimated societal costs avoided did not balance the higher intervention costs , so the incremental cost-effectiveness ratio ( ICER ) amounted to SEK100,000 per QALY for HIT versus LIT . All sensitivity analyses indicated an ICER below SEK300,000 and that HIT is the preferred option if the decision maker willingness-to-pay exceeds SEK50,000 per QALY . Compared with no intervention , LIT was cost saving , whereas HIT was estimated at SEK8,400 per QALY . CONCLUSIONS Compared with no smoking cessation program , it is a societal waste not to implement the LIT as it is estimated to result in lower societal costs . The incremental cost per QALY gained of SEK100,000 for HIT is considered very cost-effective in Sweden . Thus , if smoking cessation programs are judged in the same manner as other Swedish health care measures , the high-intensity program should be chosen before the low-cost program Background Community pharmacists can deliver health care advice at an opportunistic level , related to prescription or non-prescription medicines and as part of focused services design ed to reduce specific risks to health . Obesity , smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK , and interventions led by community pharmacists , aim ed at these three risk factors , have been identified by the government as public health priorities . In 2008 , the Department of Health for Engl and stated that ‘ a sound evidence base that demonstrates how pharmacy delivers effective , high quality and value for money services is needed ’ ; this systematic review aims to respond to this requirement . Methods / design We will search the data bases MEDLINE , Embase , CINAHL , PsycINFO , Social Sciences Citation Index , ASSIA , IBSS , Sociological Abstract s , Scopus and NHS Economic Evaluation Data base for studies that have evaluated interventions based on community pharmacies that aim to target weight management , smoking cessation and alcohol misuse . We will include all r and omised controlled trials ( RCTs ) , non-r and omised controlled trials ( N RCTs ) , controlled before-after studies ( CBAs ) and interrupted time series ( ITS ) and repeated measures studies . Data from included studies will be extracted by two independent review ers and will include study details methods , results , intervention implementation/costs and method ological quality . Meta- analysis will be conducted if appropriate ; if not , the synthesis will be restricted to a narrative overview of individual studies looking at the same question . Discussion The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management , smoking cessation and alcohol misuse . It will also explore if , and how , socio-economic status , gender , ethnicity and age moderate the effect of the interventions and will describe how the interventions included in the review have been organised , implemented and delivered , since context is an important factor governing the success of public health interventions . The findings from this review will have an impact on the commissioning of public health services aim ing to promote healthy weight , smoking cessation and prevent excessive alcohol consumption . Systematic review registration The review has been registered with PROSPERO ( registration no. CRD42013005943 ) . Available at : http://www.crd.york.ac.uk/ prospero /display_record.asp?ID = CRD42013005943 Abstract Background and Objective : Varenicline is a nicotinic acetylcholine receptor partial agonist that is approved for use as an aid to smoking cessation . R and omized clinical trials show that its efficacy is superior to that of other current smoking cessation therapies . This study set out to determine the cost effectiveness of varenicline relative to other smoking cessation interventions ( bupropion and nicotine replacement therapy [ NRT ] ) as well as brief counselling alone and unaided cessation in a cohort of Belgian adult smokers making a one-time quit attempt , from the perspective of the healthcare payer ( public and private ) . Methods : A Markov model , the Benefits of Smoking Cessation on Outcomes ( BENESCO ) model , was applied to calculate the long-term health and economic benefits of smoking cessation . Cost effectiveness was expressed as cost per life-year ( LY ) gained and cost per quality -adjusted life-year ( QALY ) gained . Clinical and economic model inputs were obtained from the literature and public healthcare data bases . Costs were discounted at 3 % and health outcomes at 1.5 % . A probabilistic sensitivity analysis and a one-way sensitivity analysis were performed to test the robustness of the results . Results : Varenicline is associated with a reduction of smoking-related morbidity and mortality as well as with a decrease in healthcare costs compared with the pharmacological agents bupropion and NRT . Varenicline also leads to additional LYs and QALYs compared with brief counselling alone and unaided cessation over a lifetime period . Varenicline is a dominant strategy compared with bupropion and NRT . Compared with brief counselling alone and unaided cessation , varenicline presents a cost/QALY of € 240 and € 1656 , respectively . Conclusion : Varenicline is a cost-effective alternative to brief counselling and unaided cessation , and is a cost-saving treatment in comparison with bupropion and NRT , in a Belgian population of smokers willing to quit INTRODUCTION Smoking prevalence remains high in some vulnerable groups , including those who misuse substances , have a mental illness , are homeless , or are involved with the criminal justice system .  E-cigarette use is increasing and may support smoking cessation/reduction . METHODS Systematic review of quantitative and qualitative data on the effectiveness of e-cigarettes for smoking cessation/reduction among vulnerable groups . Data bases search ed were MEDLINE , EMBASE , PsychINFO , CINAHL , ASSIA , ProQuest Dissertations and Theses , and Open Grey . Narrative synthesis of quantitative data and thematic synthesis of qualitative data . RESULTS 2628 records and 46 full texts were screened ; 9 studies were identified for inclusion . Due to low quality of evidence , it is uncertain whether e-cigarettes are effective for smoking cessation in vulnerable population s. A moderate quality study suggested that e-cigarettes were as effective as nicotine replacement therapy . Four studies suggested significant smoking reduction ; however , three were uncontrolled and had sample sizes below 30 . A prospect i ve cohort study found no differences between e-cigarette users and nonusers . No significant adverse events and minimal side effects were identified . Qualitative thematic synthesis revealed barriers and facilitators associated with each component of the COM-B ( capability , opportunity , motivation , and behavior ) model , including practical barriers ; perceptions of effectiveness for cessation/reduction ; design features contributing to automatic and reflective motivation ; smoking bans facilitating practical opportunity ; and social connectedness increasing social opportunity . CONCLUSION Further research is needed to identify the most appropriate device types for practicality and safety , level of support required in e-cigarette interventions , and to compare e-cigarettes with current best practice smoking cessation support among vulnerable groups . IMPLICATION S Smoking prevalence among people with mental illness , substance misuse , homelessness , or criminal justice system involvement remains high . E-cigarettes could support cessation . This systematic review found limited quantitative evidence assessing effectiveness . No serious adverse events were identified . Qualitative thematic synthesis revealed barriers and facilitators mapping to each component of the COM-B ( capability , opportunity , motivation , and behavior ) model , including practical barriers ; perceived effectiveness ; design features contributing to automatic and reflective motivation ; smoking bans facilitating practical opportunity ; and social connectedness increasing social opportunity . Further research should consider appropriate devices for practicality and safety , concurrent support , and comparison with best practice smoking cessation support Women frequently quit smoking during pregnancy but then relapse postpartum . The BABY & ME — Tobacco Free program combines prenatal and postpartum smoking cessation counseling and biomarker feedback with monthly postpartum incentives . The setting s included 22 sites ( WIC offices and prenatal clinics ) in upstate New York . A quasi-experimental design was used to evaluate this intervention , that included four face-to-face prenatal sessions with a counselor who did smoking cessation counseling , carbon monoxide testing and r and om saliva cotinine testing . For 1 year postpartum , mothers were biochemically tested every 3–4 weeks and , if negative , were issued a voucher for diapers . Three implementation models were studied : multi-tasking counselors at fixed sites ( Models 1 and 2 ) versus itinerant smoking cessation specialists ( Model 3 ) . Outcomes included biochemically vali date d abstinence rates during pregnancy and postpartum . Logistic regression was used to identify predictors of postpartum abstinence and program dropout . Proportional hazards regression was used to compare implementation models . Of the 777 pregnant women who enrolled in the program , 588 were eligible for the postpartum program . The intention to treat pregnancy quit rate was 60 % . Postpartum , Model 3 showed consistently better quit outcomes than the other models . Predictors of abstinence at 6 months postpartum are : older age ( OR = 1.07 , 95 % C.I. 1.02–1.12 ) , lower baseline carbon monoxide level ( OR = 0.69 , 95 % C.I. 0.49–0.97 ) , Model 3 ( OR = 4.60 , 95 % C.I. 2.80–7.57 ) and attending more prenatal sessions ( OR = 3.52 ; 95 % C.I. 2.19–5.65 ) . The BABY & ME — Tobacco Free program is an effective smoking cessation program for pregnant and parenting women Background A new model of complex diabetes care is provided by a multidisciplinary team which incorporates general practitioner ( GP ) Clinical Fellows supported by an Endocrinologist and diabetes educator within a community-based general practice setting . This study evaluates the health and clinical benefits of the new model of care , assesses the acceptability of the model to patients , GPs and other health professionals , and examines the cost-effectiveness of the model . Methods / Design The study is an open , non-inferiority r and omised controlled trial with data collected at baseline , 6 and 12 months . Participants are identified from new patients on hospital-based diabetes outpatient clinic waiting lists and new GP referrals . Eligible consenting patients are r and omised to either a community practice site ( intervention ) or a hospital site ( usual care ) . In the intervention model , medical care is led by a GP Clinical Fellow in partnership with an Endocrinologist . Quantitative measures include clinical indicators with HbA1c as the primary outcome ; patient-reported outcomes include health-related quality of life , mental health and satisfaction with care . Qualitative methods will be used to explore the perspectives and experiences of patients and providers regarding the new model of care . An economic evaluation will also be undertaken . Discussion This model of care seeks to improve the quality and safety of healthcare at the interface between the hospital and primary care sectors for patients with complex diabetes . The study will provide empirical evidence about the impact of the model of care on health outcomes , patient and clinician satisfaction , as well as any economic impacts . Trial registration Clinical Trials Registry Number : BACKGROUND The aim of this study was to evaluate and compare the cost-effectiveness of varenicline with nicotine replacement therapy ( NRT ) for smoking cessation in four European countries ( Belgium , France , Sweden and the UK ) . METHODS Markov simulations , using the Benefits of Smoking Cessation on Outcomes ( BENESCO ) model , were performed . We simulated the incidence of four smoking-related morbidities : lung cancer , chronic obstructive pulmonary disease , coronary heart disease and stroke . The model computes quality -adjusted life-years gained and incremental cost-effectiveness ratios . Incremental cost-utility ratios were calculated , adopting a lifetime perspective . Efficacy data were obtained from a r and omized open-label trial : Week 52 continuous abstinence rates were 26.1 % for varenicline and 20.3 % for NRT . RESULTS The analyses imply that for countries analysed , smoking cessation using varenicline versus NRT was associated with reduced smoking-related morbidity and mortality . The number of morbidities avoided , per 1000 smokers attempting to quit , ranged from 9.7 in Belgium to 6.5 in the UK . The number of quality -adjusted life-years gained , per 1000 smokers , was 23 ( Belgium ) ; 19.5 ( France ) ; 29.9 ( Sweden ) ; and 23.7 ( UK ) . In all base-case simulations ( except France ) , varenicline dominated ( more effective and cost saving ) NRT regarding costs per quality -adjusted life-year gained ; for France the incremental cost-effectiveness ratio was 2803 . CONCLUSION This cost-effectiveness analysis demonstrated that since varenicline treatment was more effective , the result was increased healthcare cost savings in Belgium , Sweden and the UK . Our results suggest that funding varenicline as a smoking cessation aid is justifiable from a healthcare re source allocation perspective
All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context
AIMS To identify different types of models used in economic evaluations of smoking cessation , analyse the quality of the included models examining their attributes and ascertain their transferability to a new context .