Analytical approach:
The economic evaluation was based on a simple decision tree model. A very short-term four-week time horizon was considered for the cost-effectiveness analysis and a longer-term 52-week time horizon was considered for the cost-utility analysis. The authors stated that the perspective of the UK National Health Service (NHS) was adopted.
Effectiveness data:
The clinical data came from an ongoing observational study implemented in Glasgow and from published studies. The observational study provided initial data (at four weeks) on the treatment effect, based on 1,979 smokers (1,508 for Starting Fresh and 571 for Smoking Concerns), who accessed the cessation services between March and May 2007. There were differences in age, sex and other characteristics between the two groups. The primary clinical endpoint was the quit rate and, for self-quitters, this was based on published evidence for the UK and authors’ assumptions. The long-term (at one year) quit rate was based on other published studies.
Monetary benefit and utility valuations:
No details were given of the methods used to obtain the utility weights, but the total quality-adjusted life-years (QALYs) were taken directly from the literature.
Measure of benefit:
The summary benefit measure was the quit rate. A rough estimate of the expected QALYs was also calculated using published evidence and authors’ opinions.
Cost data:
The four broad categories of costs were nicotine replacement therapy (NRT), professional time, overheads, and materials. A breakdown of the cost items was provided. Resource use data were derived from the observational study using patient level data. The costs were obtained from the NHS Greater Glasgow and Clyde data. They were in UK pounds sterling (£) and the price year was 2007.
Analysis of uncertainty:
Different definitions of quitters were considered in the sensitivity analysis. While the base-case analysis classified quitters as those who were carbon monoxide-validated, alternative scenarios considered self-reported quitters or those who remained in the programme for four weeks after quitting. The quit rate was also varied by ±5%. Another scenario incorporated the additional costs to the NHS for the self-quit control group, which assumed a further general practitioner consultation and a prescription of NRT. A change in the fee paid to the pharmacists for patients who completed the programme was also assessed.