Abstract
Objective
This systematic review examined the characteristics of published cost-effectiveness analyses of inpatient smoking cessation programs and assessed the methodological quality of the selected studies, to provide policymakers with economic evidence for this type of program.
Methods
A literature search was undertaken using a relevant database by three investigators. Only full economic evaluations with results in the form of the incremental cost-effectiveness ratio (ICER) were included. Costs were adjusted to 2016 US dollars using the Gross Domestic Product deflator and purchasing power parities. The British Medical Journal checklist was utilized to appraise the methodological quality of the included studies.
Results
Nine articles were ultimately selected. The inpatient smoking cessation programs appeared to be a highly cost-effective intervention according to the recommended cost-effectiveness thresholds by the World Health Organization or individual studies. The highest ICERs among the selected studies were $5593 per additional quit, $10,550 per life year gained, and $5680 per quality-adjusted life year gained.
Conclusions
This study provides robust evidence supporting the cost-effectiveness of smoking cessation programs for hospitalized patients. In addition, the results indicated that the degree of cost-effectiveness of the inpatient smoking cessation program might not be related to either the components of the program or methodological variations in the cost-effectiveness analysis. Policymakers should provide hospitals with resources and strong incentives to promote wider implementation of the smoking cessation program.
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Acknowledgements
We are grateful to two anonymous reviewers for helpful comments on an earlier version of this article. This research was partially supported by a grant from the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (Grant No. HI 13C0729).
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Appendices
Appendix 1: A detailed description of the search strategy
MEDLINE (Pubmed)—January 5th 2018
No | Query | Items found |
|---|---|---|
1 | “Economics”[Mesh:NoExp] | 26,846 |
2 | “Costs and Cost Analysis”[Mesh] | 210,906 |
3 | “Economics, Dental”[Mesh:NoExp] | 1891 |
4 | “Economics, Hospital”[Mesh] | 22,563 |
5 | “Economics, Medical”[Mesh:NoExp] | 8929 |
6 | “Economics, Nursing”[Mesh:NoExp] | 3978 |
7 | “Economics, Pharmaceutical”[Mesh:NoExp] | 2729 |
8 | ((((((((economic*[Title/Abstract]) OR cost[Title/Abstract]) OR costs[Title/Abstract]) OR costly[Title/Abstract]) OR costing[Title/Abstract]) OR price[Title/Abstract]) OR prices[Title/Abstract]) OR pricing[Title/Abstract]) OR pharmacoeconomic*[Title/Abstract] | 659,584 |
9 | (expenditure*[Title/Abstract]) NOT energy[Title/Abstract] | 24,853 |
10 | “value for money”[Title/Abstract] | 1273 |
11 | budget*[Title/Abstract] | 25,117 |
12 | OR 1–11 | 788,598 |
13 | (“energy cost”[Title/Abstract]) OR “oxygen cost”[Title/Abstract] | 3604 |
14 | “metabolic cost”[Title/Abstract] | 1189 |
15 | (“energy expenditure”[Title/Abstract]) OR “oxygen expenditure”[Title/Abstract] | 21,820 |
16 | 13 OR 14 OR 15 | 25,699 |
17 | 12 NOT 16 | 782,696 |
18 | “inpatients”[Mesh] OR “hospitalization”[Mesh] | 214,989 |
19 | “smoking cessation”[Mesh] OR “tobacco use cessation”[Mesh] OR “smoking prevention”[Mesh] | 36,703 |
20 | 18 AND 19 | 663 |
21 | 17 AND 20 | 82 |
EMBASE—January 5th 2018
No | Query | Items found |
|---|---|---|
1 | ‘health economics’ | 68,843 |
2 | ‘economic evaluation’/exp | 265,952 |
3 | ‘health care cost’/exp | 255,559 |
4 | ‘pharmacoeconomics’/exp | 187,487 |
5 | #1 OR #2 OR #3 OR #4 | 597,244 |
6 | ‘economic’:ab,ti OR ‘economics’:ab,ti OR ‘cost’:ab,ti OR ‘costs’:ab,ti OR ‘costly’:ab,ti OR ‘costing’:ab,ti OR ‘price’:ab,ti OR ‘prices’:ab,ti OR ‘pricing’:ab,ti OR ‘pharmacoeconomic’:ab,ti OR ‘pharmacoeconomics’:ab,ti | 791,745 |
7 | ‘expenditure’:ab,ti NOT ‘energy’:ab,ti | 19,835 |
8 | ‘value for money’:ab,ti | 1894 |
9 | ‘budget’:ab,ti | 22,645 |
10 | #6 OR #7 OR #8 OR #9 | 813,367 |
11 | #5 OR #10 | 1,139,823 |
12 | ‘metabolic cost’:ab,ti | 1260 |
13 | ‘energy cost’:ab,ti OR ‘oxygen cost’:ab,ti | 3832 |
14 | ‘energy expenditure’:ab,ti OR ‘oxygen expenditure’:ab,ti | 27,108 |
15 | #12 OR #13 OR #14 | 31,208 |
16 | #11 NOT #15 | 1,133,545 |
17 | ‘hospital patient’/exp OR ‘hospitalization’/exp | 407,694 |
18 | ‘smoking cessation’/exp | 49,862 |
19 | #17 AND #18 | 1640 |
20 | #16 AND #19 | 314 |
Cochrane Library—January 5th 2018
No | Query | Items found |
|---|---|---|
1 | smoking cessation | 178 |
NHS EED—January 5th 2018
No | Query | Items found |
|---|---|---|
1 | “smoking cessation”[Mesh] | 475 |
CEA Registry—January 5th 2018
No | Query | Items found |
|---|---|---|
1 | smoking cessation | 81 |
Appendix 2: The results of the methodological quality assessment using the BMJ checklist
Study design | Data collection | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
(1) Study question | (2) Selection of alternatives | (3) Form of evaluation | (4) Effectiveness data | |||||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
Krumholz et al. | Y | N/C | N | N/C | Y | Y | N/C | Y | Y | N/A |
Croghan et al. | Y | N | N | N | Y | Y | N/C | Y | Y | N/A |
Meenan et al. | Y | N | Y | Y | Y | Y | N/C | Y | Y | N/A |
Prathiba et al. | Y | N | N | N/C | Y | Y | N/C | Y | Y | N/A |
Quist-Paulsen et al. | Y | N | N | N/C | Y | Y | N/C | Y | Y | N/A |
Ladapo et al. | Y | Y | Y | Y | Y | Y | Y | Y | N/A | Y |
Mullen et al. | Y | Y | Y | Y | Y | Y | Y | Y | Y | N/A |
Barnett et al. | Y | Y | N | Y | Y | Y | Y | Y | Y | N/A |
Berndt et al. | Y | Y | Y | Y | Y | Y | Y | Y | Y | N/A |
Data collection | Analysis and interpretation of results | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
(5) Benefit measurement and valuation | (6) Costing | (7) Modeling | (8) Adjustments for timing of costs and benefits | ||||||||||||
11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | |
Krumholz et al. | Y | N | N | N | Y | Y | Y | N/C | N | Y | Y | N | Y | N | N |
Croghan et al. | Y | N | N | N | N | N | N | Y | Y | N/C | N | Y | Y | Y | Y |
Meenan et al. | Y | N | N | N | N | N/C | N/C | Y | Y | Y | Y | N/C | Y | Y | Y |
Prathiba et al. | Y | N | N | N | N | Y | Y | N/C | N | N/A | N/A | N | N | N | N |
Quist-Paulsen et al. | Y | N | N | N | Y | N/C | N/C | Y | Y | Y | N/C | Y | Y | Y | Y |
Ladapo et al. | Y | Y | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | Y | Y | N/A |
Mullen et al. | Y | N | Y | N | N | N | N | Y | N/C | Y | N/C | Y | Y | Y | N/A |
Barnett et al. | Y | Y | Y | N | N | N | N | Y | Y | Y | Y | Y | Y | N | N/A |
Berndt et al. | Y | Y | Y | Y | Y | N | N | Y | Y | N/A | N/A | Y | Y | Y | Y |
Analysis and interpretation of results | Score | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
(9) Allowance for uncertainty | (10) Presentation of results | ||||||||||
26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34 | 35 | ||
Krumholz et al. | N | Y | Y | Y | Y | Y | Y | Y | Y | Y | 0.618 |
Croghan et al. | N | Y | N | Y | Y | Y | Y | Y | Y | Y | 0.588 |
Meenan et al. | Y | Y | Y | Y | Y | Y | N/C | Y | Y | Y | 0.706 |
Prathiba et al. | Y | Y | N/C | N/C | Y | Y | N | Y | Y | N | 0.438 |
Quist-Paulsen et al. | Y | Y | N/C | N/C | Y | Y | Y | Y | Y | Y | 0.647 |
Ladapo et al. | N | Y | Y | Y | Y | Y | Y | Y | Y | Y | 0.939 |
Mullen et al. | Y | Y | N | N | Y | Y | Y | Y | Y | Y | 0.727 |
Barnett et al. | N | Y | N/C | Y | Y | Y | Y | Y | Y | Y | 0.758 |
Berndt et al. | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | 0.938 |
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Lee, D., Lee, YR. & Oh, IH. Cost-effectiveness of smoking cessation programs for hospitalized patients: a systematic review. Eur J Health Econ 20, 1409–1424 (2019). https://doi.org/10.1007/s10198-019-01105-7
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DOI: https://doi.org/10.1007/s10198-019-01105-7