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Economic evaluation of a telephone- and face-to-face-delivered counseling intervention for smoking cessation in patients with coronary heart disease

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Abstract

Objective

This study examined the cost-effectiveness and cost-utility of two smoking cessation counseling interventions differing in their modality for patients diagnosed with coronary heart disease from a societal perspective.

Methods

In a randomized controlled trial conducted in Dutch hospital wards, cardiac patients who smoked prior to admission were allocated to usual care (n = 245), telephone counseling (n = 223) or face-to-face counseling (n = 157). The counseling interventions lasted for 3 months and were complemented by nicotine patches. Baseline histories were obtained, and interviews took place 6 months after hospitalization to assess self-reported smoking status and quality adjusted life years (QALYs). Incremental cost-effectiveness ratios per quitter and cost-utility ratios per QALY were calculated and presented in acceptability curves. Uncertainty was accounted for by sensitivity analysis.

Results

Using continued abstinence as the outcome measure showed that telephone counseling had the highest probability of being cost-effective. Face-to-to-face counseling was also more cost-effective than usual care. No significant improvements and differences in QALYs between the three conditions were found. Varying costs and effect estimations revealed that the results of the primary analyses were robust.

Conclusions

Assuming a willingness-to-pay of €20,000 per abstinent patient, telephone counseling would be a highly cost-effective smoking cessation intervention assisting cardiac patients to quit. However, the lack of consensus concerning the willingness-to-pay per quitter impedes drawing firm conclusions. Moreover, studies with extended follow-up periods are needed to capture late relapses and possible differences in QALYs.

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Acknowledgments

This project was financed by ZonMw, the Dutch Organisation for Health Research and Development (grant number: 50-50110-96-524). The authors acknowledge collaboration with the Dutch Expert Center for Tobacco Control (STIVORO), and the hospital offers and cardiac nurses of the participating hospitals. A particular thanks goes to all patients for their participation in this study and to Esther Kers for the data-entry.

Conflict of interest

The authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. Faculty of Psychology and Educational Sciences, Open University of the Netherlands, POB 2960, 6401 DL, Heerlen, The Netherlands

    Nadine Berndt, Catherine Bolman, Lilian Lechner & Aart Mudde

  2. Cellule d’expertise médicale, Inspection générale de la sécurité sociale, Le Gouvernement du Grand-Duché de Luxembourg, POB 1308, 1013, Luxembourg, Luxembourg

    Nadine Berndt

  3. Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, CA, 94118, USA

    Wendy Max

  4. Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands

    Hein de Vries

  5. Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands

    Silvia Evers

  6. Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, POB 725, 3500 AS, Utrecht, The Netherlands

    Silvia Evers

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  1. Nadine Berndt
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  2. Catherine Bolman
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  3. Lilian Lechner
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  4. Wendy Max
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  6. Hein de Vries
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Correspondence to Nadine Berndt.

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Berndt, N., Bolman, C., Lechner, L. et al. Economic evaluation of a telephone- and face-to-face-delivered counseling intervention for smoking cessation in patients with coronary heart disease. Eur J Health Econ 17, 269–285 (2016). https://doi.org/10.1007/s10198-015-0677-x

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  • DOI: https://doi.org/10.1007/s10198-015-0677-x

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