Cost-Effectiveness of an Intensive Tobacco-Dependence Intervention Based on Self-Determination Theory: An Analysis from the Third-Party Payer's Perspective

Tobacco-dependence continues to be a leading preventable cause of death with high medical costs. The objective of this study was to evaluate the cost-effectiveness (CE) of an intensive tobacco-dependence intervention based on self-determination theory (SDT) from the third-party payer's perspective. We compared tobacco-dependence intensive intervention to community care available in a midsized upstate New York community. Insured participants (n=737) were randomized to either a six-month intensive intervention or a community care condition. Both groups received smoking cessation information and local resources. Additionally, participants randomized to the intervention were offered four visits with a tobacco-dependence counselor to discuss their health using the SDT model. If they had the desire to quit, the counselor offered additional support (e.g. medications and skills building). The primary outcome measure was the incremental CE ratios based on non-biomedical validated 7-day point prevalence tobacco abstinence at 6 months from randomization and calculated by dividing incremental costs per participant by incremental quality-adjusted-life-year (QALY) saved due to abstinence from tobacco. The study results show that the overall incremental CE ratio, discounted at 3%, was US$1,259.0 per QALY saved, and ranged from US$645.0 to US$2,674.6 per QALY saved. Sensitivity analyses performed included biomedical validated tobacco-abstinence, use of generic medications, and use of subpopulation of smokers who did not plan to quit in the next month, all leading to similar findings. These results underscore the importance of policy makers' and independent insurers' supporting implementation of intensive tobacco-dependence interventions in primary care settings.