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Title: Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD
Authors: Huber, M
Präger, M
Coyle, K
Coyle, D
Lester-George, A
Trapero-Bertran, M
Nemeth, B
Cheung, KL
Stark, R
Vogl, M
Pokhrel, S
Leidl, R
Keywords: Smoking cessation;Germany;Cost effectiveness;Behavioral support;Pharmacotherapy;Policy;EQUIPTMOD
Issue Date: 2017
Publisher: WILEY
Citation: Addiction,(2017)
Abstract: Aims: To evaluate costs, effects and cost effectiveness of increased reach of specific smoking cessation interventions in Germany. Design: A Markov-based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A healthcare perspective (extended to include out-of-pocket payments) with lifetime horizon was considered. A probabilistic analysis was used to assess uncertainty around predicted estimates. Setting: Germany. Participants: Cohort of current smoking population (18+ years) in Germany. Interventions: Interventions included group-based behavioral support, financial incentive programs and varenicline. For Prospective Scenario 1 the reach of group-based behavioral support, financial incentive program and varenicline was increased by 1% of yearly quit attempts (=57,915 quit attempts), while Prospective Scenario 2 represented a higher reach mirroring the levels observed in England. Measurements: EQUIPTMOD considered reach, intervention cost, number of quitters, QALYs gained, cost effectiveness and return on investment. Findings: The highest returns through reduction in smoking-related healthcare costs were seen for the financial incentive program (€2.71 per €1 invested), followed by that of group-based behavioral support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, Prospective Scenario 1 led to 15,034 QALYs gained and €27 million cost-savings, compared with Current Investment. Intervention effects and reach contributed most to the uncertainty around the return-on-investment estimates. At a hypothetical willingness-to-pay threshold of only €5,000, the probability of being cost effective is around 75% for Prospective Scenario 1. Conclusions Increasing the reach of group-based behavioral support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policy makers that improves the population’s health outcomes and that may be considered cost-effective.
ISSN: 0965-2140
Appears in Collections:Dept of Clinical Sciences Research Papers

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