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.

The objective was to assess the cost-effectiveness of three smoking cessation strategies that combined training for general practitioners (GPs) with financial incentives, medication for patients, or both. The authors concluded that GP training and full patient reimbursement for nicotine replacement therapy, with or without financial incentives for GPs, were cost-effective smoking cessation interventions. The methods were valid and the main limitations were highlighted and discussed. The conclusions reached by the authors reflected the scope of their analysis.

Cost-effectiveness analysis

The aim was to compare the cost-effectiveness of three smoking cessation strategies that were provided by general practitioners (GPs) to patients who were aged between 36 and 75 years, were smoking at least 10 cigarettes per day, and were visiting their GPs for a general check-up.

The three strategies were training with incentives, training with medication, and training with incentives and medication. The training was provided by the GP and was on smoking cessation methods. The incentives were remuneration for the GP for each abstinent patient. The medication was nicotine replacement therapy, bupropion hydrochloride, or both and it was free to the patients (up to a maximum of 130 Euros). These strategies were compared with the usual care.

Germany/primary care.

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The expected prevalence of abstinence at one year was two patients (2.7%) for usual care, five patients (3.5%) for training with incentives, 17 patients (12.1%) for training with medication, and 32 patients (14.6%) for training with both incentives and medication. There was a statistically significant difference between medication and usual care (p=0.05) and both and usual care (p=0.02), but not between incentives and usual care (p=0.75), nor between medication and both. The total intervention cost per patient treated was zero for usual care, EUR 14.16 with incentives, EUR 39.10 with medication, and EUR 50.04 with both.

When medication was compared against usual care, the incremental cost per 1% increase in abstinent patients was EUR 4.14. When both was compared against usual care the ICER was EUR 4.21 per 1% increase in abstinent patients. When medication was compared with both the ICER was EUR 4.37 per 1% increase in abstinent patients.

These results were relatively robust to the variations tested in the sensitivity analyses.

The authors concluded that training GPs on smoking cessation and full patient reimbursement for nicotine replacement therapy with or without further financial incentives for GPs, were cost-effective smoking cessation interventions, compared with the usual care in the authors’ setting.

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Funded by the Federal Ministry for Education and Research, Germany.

Twardella D, Brenner H. Strategies to improve smoking cessation promotion in general practice: results of a cluster randomised trial. Tobacco Control 2007; 16(1): 15-21.