The cost-effectiveness of the English smoking treatment services: evidence from practice

AIMS

To investigate the cost-effectiveness of English specialist smoking cessation services.

DESIGN

Combination of observational cost and outcome data from English smoking cessation services to calculate cost-effectiveness ratios. Multivariate analysis of factors influencing variation in services' cost-effectiveness.

SETTING

Fifty-eight of the 92 specialist smoking cessation services in England in 2000/01.

METHODS

Services' costs were estimated using survey data which described services' configurations, staffing, interventions delivered and development. Information on services' throughput and outcomes (as biochemically validated 4-week smoking cessation rates) were obtained from routine sources. With reference to relevant literature and assumptions about relapse and background cessation rates, 4-week cessation rates were converted first to 1-year rates. One-year cessation rates were adjusted to reflect the likely permanent smoking cessation rate attributable to service intervention and finally attributable life-years gained were calculated. A wide variety of sensitivity analyses was performed to test the robustness of the average cost-effectiveness ratio, calculated by combining the cost and life-year gained estimates, for all services. With additional data on deprivation levels in services' areas, ordinary least-squares regression techniques were used to investigate variations in individual services' costs per client and cost-effectiveness ratios.

FINDINGS

Using an up-to-date estimate for health gain accrued by stopping smoking, the average cost per life gained was £684 (95% CI 557–811), falling to £438 when savings in future health-care costs were counted. With the worst case assumptions, the estimate of cost-effectiveness rose to £2693 per life-year saved (£2293 including future health-care costs) and fell to £227 (£102) under the most favourable assumptions. Findings are comparable to previous published studies. The regression results suggest that different factors influence cost per client and the net cost per life-year saved, indicating that decision makers should be careful in setting performance targets for these services.

CONCLUSIONS

In 2000/01, English smoking cessation services provided cost-effective services operating well below the benchmark of £20 000 per quality-adjusted life-year saved (QALY) that is used by the National Institute for Clinical Excellence in the United Kingdom.