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Effect of smoking cessation advice on cardiovascular disease |
Eddy DM, Peskin B, Shcheprov A, Pawlson G, Shih S, Schaaf D |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study evaluated the effect of providing advice about the importance of smoking cessation and the availability of counselling and medication in the prevention of morbidity, mortality, and costs related to cardiovascular disease. The authors concluded that the provision of this advice reduced the associated morbidity, mortality and costs. The methods appear to have been satisfactory, but the data sources were not fully described. The authors' conclusions appear to be appropriate. Type of economic evaluation Study objective To evaluate the effect of smoking cessation advice in the prevention of morbidity, mortality, and costs related to cardiovascular disease. The target population was people aged 18 to 85 years, who smoked. Interventions Three strategies were compared: no advice, basic advice, and medication advice. In basic advice, once a year nurses identified people who smoked, and physicians advised them about the importance of stopping and the availability of counselling. Medication advice was the same as basic advice, but included a discussion of the availability of medication. Methods Analytical approach:This economic evaluation was based on a published mathematic model, called the Archimedes model, with a 30-year time horizon. The authors did not state the perspective.
Effectiveness data:The variables, including the prevalence of smoking, that affected the rate cardiovascular disease in the population came from the National Health and Nutrition Education Survey (NHANES) from 1988 to 1994. A key parameter was the percentage of smokers who chose to participate in the smoking cessation programme. This was estimated based on the observed rates of cessation published by the Agency for Health Care Policy and Research, USA. Meta-analyses were conducted to produce these cessation rates. The occurrence and progression of cardiovascular disease were already incorporated in the Archimedes model.
Monetary benefit and utility valuations:: The health utility values were based on a published study, the details of which were not given.
Measure of benefit:Quality-adjusted life-years (QALYs) were the summary benefit measure and future QALYs were discounted at an annual rate of 3%.
Cost data:The economic analysis considered two broad categories: advice costs and general medical costs, such as tests, procedures, and treatments. Advice or counselling costs were based on Medicare reimbursement and a published study (Cromwell, et al. 1997, see 'Other Publications of Related Interest' below for bibliographic details). The drug costs were based on online prices. General medical costs were calculated using a micro-costing method and reflected those costs incurred by a health insurance organisation (Kaiser Permanente). All costs were expressed in US dollars ($) and a 3% annual discount rate was applied.
Analysis of uncertainty:One-way sensitivity analyses were carried out to assess the impact of variations in some baseline estimates, using ranges of plus or minus 20% or 50%. Results In the US population aged 18 to 85 years, approximately 65 million people smoke. Giving no advice to these smokers resulted in approximately 895 million QALYs, basic advice resulted in an additional 3.3 million QALYs and medication advice resulted in an additional 4.8 million QALYs. Over 15 years, the total cost of care was $1,185,029 million with no advice. It was an additional $36,580 million with basic advice and $55,811 million with medication advice.
Over 30 years, the incremental cost per additional QALY over no advice was $2,646 with basic advice and $3,232 with medication advice. The sensitivity analysis did not substantially alter the base-case findings. Authors' conclusions The authors concluded that the provision of simple advice about the importance of smoking cessation and the availability of counselling and medication substantially reduced the morbidity, mortality, and costs associated with cardiovascular disease. CRD commentary Interventions:A clear description of each intervention was given. Basic and medication advice were appropriate comparators as they were recommended in the authors’ setting.
Effectiveness/benefits:The authors did not report any methods used to identify the clinical evidence, but they did report the sources. The Archimedes model was a well-established, peer-reviewed model and the cessation rates were from evidence-based guidelines. The evidence on cardiovascular disease progression was already incorporated in the published decision model. The benefit measure was appropriate, but no description of the sources used to derive the utility values was provided.
Costs:The economic viewpoint was not explicitly reported, but appears, from the categories of costs and some of their sources, to have been that of the health care system. There was limited information on the resources used, particularly those for cardiovascular disease. The authors described the sources used to derive the data and these are likely to have reflected the US accounting system. The price year was not explicitly reported, but appears to have been 2007. The costs were presented as macro-categories and a detailed breakdown of items was not given. This reduces the transparency of the economic analysis. The costs were treated deterministically, but some key estimates were varied in the sensitivity analysis.
Analysis and results:The results and analysis were adequately presented. The synthesis of the costs and benefits was appropriate. The issue of uncertainty was investigated using a deterministic approach, but probabilistic sensitivity analyses would have been more useful to fully ascertain the parameter uncertainty. The authors compared their findings with those from a published study.
Concluding remarks:The methods appear to have been satisfactory, but the sources of data were not fully described. The authors' conclusions appear to be appropriate. Bibliographic details Eddy DM, Peskin B, Shcheprov A, Pawlson G, Shih S, Schaaf D. Effect of smoking cessation advice on cardiovascular disease. American Journal of Medical Quality 2009; 24(3): 241-249 Other publications of related interest Cromwell J, Bartosch WJ, Fiore MC, Hasselblad V, Baker T. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research. JAMA 1997; 278: 1759-1766. Indexing Status Subject indexing assigned by NLM MeSH Cardiovascular Diseases /economics /prevention & Costs and Cost Analysis; Counseling; Humans; Models, Econometric; Quality-Adjusted Life Years; Smoking Cessation; United States; control AccessionNumber 22009103153 Date bibliographic record published 28/10/2009 Date abstract record published 30/06/2010 |
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