Cost-effectiveness of in-hospital motivational smoking cessation counselling and proactive referral to community-based follow-up

Background Hospital-based smoking cessation interventions are generally cost-effective, but most economic evaluations among inpatients with atherosclerotic cardiovascular disease (ASCVD) rely on modelled data only rather than patient-level data (1). Moreover, cost-effectiveness evidence for motivational interviewing in smoking cessation is limited and is primarily derived from non-hospitalised populations (2,3). Purpose To evaluate the cost-effectiveness of an in-hospital smoking cessation intervention with proactive referral to community-based follow-up among patients with ASCVD. Methods We performed an economic evaluation alongside a randomised controlled trial using a hospital perspective. The analysis included the cost of training, materials, and personnel. We recorded survival over sixteen months. Hospital costs during this period were monetised using Diagnosis Related Group cost weights. Survival beyond follow-up was projected using national mortality data adjusted for age, sex, and ASCVD. Remaining lifetime costs were estimated from mean costs in the final six months of follow-up. Costs and life-years were discounted at four percent. Uncertainty was assessed with 2000 bootstrap replicates. The primary outcome was net monetary benefit using a willingness-to-pay threshold of €38,346 per life-year. Results Mean baseline age was 65.2 years. During the sixteen-month follow-up, five participants in the intervention group and nine in the control group died. The intervention group had lower per-patient hospital costs during follow-up (€9,114 versus €13,973; difference: €4,859; 95% confidence interval [CI]: –€1,514 to €11,232). Lifetime costs were higher in the intervention group due to longer projected survival (€114,170 versus €110,522; difference: €3,648; uncertainty estimates [UE]: -€19,816 to €27,718). Undiscounted remaining life expectancy was 20.5 years in the intervention group and 18.7 years in the control group, (difference: 1.7 years, 95% UE: –1.9 to 6.1). The estimated net monetary benefit was €37,475 (95% CI: -15,868 to 107,797) and the probability that the intervention was cost-effective at the €38,346 per life-year threshold was 90.5% (Figure). Conclusion An in-hospital, motivational smoking cessation intervention with proactive referral to community-based support is likely to be cost-effective from a hospital perspective for patients with atherosclerotic vascular disease.FigureFor image description, please refer to the figure legend and surrounding text.