Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment

• Published in: Nicotine & tobacco research Vol. 18; no. 3; p. 267
• Main Authors: Barnett, Paul G, Jeffers, Abra, Smith, Mark W, Chow, Bruce K, McFall, Miles, Saxon, Andrew J
• Format: Journal Article
• Language: English
• Published: England 01.03.2016
• Subjects: Adult; Aged; Aged, 80 and over; Cost-Benefit Analysis - methods; Female; Health Care Costs; Humans; Male; Mental Health Services - economics; Middle Aged; Quality of Life; Quality-Adjusted Life Years; Referral and Consultation; Smoking - economics; Smoking - epidemiology; Smoking - therapy; Smoking Cessation - economics; Smoking Cessation - methods; Stress Disorders, Post-Traumatic - economics; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - therapy; United States - epidemiology; United States Department of Veterans Affairs - economics; Veterans; Young Adult; United States
• ISSN: 1469-994X
• DOI: 10.1093/ntr/ntv094

We examined the cost-effectiveness of smoking cessation integrated with treatment for post-traumatic stress disorder (PTSD). Smoking veterans receiving care for PTSD (N = 943) were randomized to care integrated with smoking cessation versus referral to a smoking cessation clinic. Smoking cessation services, health care cost and utilization, quality of life, and biochemically-verified abstinence from cigarettes were assessed over 18-months of follow-up. Clinical outcomes were combined with literature on changes in smoking status and the effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness over a lifetime horizon. We discounted cost and outcomes at 3% per year and report costs in 2010 US dollars. The mean of smoking cessation services cost was $1286 in those randomized to integrated care and $551 in those receiving standard care (P < .001). There were no significant differences in the cost of mental health services or other care. After 12 months, prolonged biochemically verified abstinence was observed in 8.9% of those randomized to integrated care and 4.5% of those randomized to standard care (P = .004). The model projected that Integrated Care added $836 in lifetime cost and generated 0.0259 quality adjusted life years (QALYs), an incremental cost-effectiveness ratio of $32 257 per QALY. It was 86.0% likely to be cost-effective compared to a threshold of $100 000/QALY. Smoking cessation integrated with treatment for PTSD was cost-effective, within a broad confidence region, but less cost-effective than most other smoking cessation programs reported in the literature.