Cost-effectiveness of a Smoking Cessation Intervention for Parents in Pediatric Primary Care

Drouin, Olivier; Sato, Ryoko; Drehmer, Jeremy E.; Nabi-Burza, Emara; Walters, Bethany Hipple; Winickoff, Jonathan P.; Levy, Douglas E.

doi:10.1001/jamanetworkopen.2021.3927

Cited by 10 publications

(8 citation statements)

References 18 publications

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“…The cessation rates observed in the trial were modest and somewhat lower than seen in other trials in the health care setting ( 49–51 , 53 ). This is likely because individuals attending lung cancer screening are older, heavier, and longer-term smokers than smokers in the general population, the broad inclusion criteria in which over one-half were not ready to quit smoking at baseline and may have tried cessation interventions before, making them more refractory to these interventions ( 7 , 54 ).…”

Section: Discussioncontrasting

confidence: 65%

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Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting

Cao

Smith

Mandelblatt

et al. 2022

JNCI Cancer Spectrum

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Background There are limited data on the cost-effectiveness of smoking cessation interventions in lung cancer screening settings. We conducted an economic analysis embedded in a national randomized trial of two telephone counseling cessation interventions. Methods We used a societal perspective to compare the short-term cost per 6-month bio-verified quit and long-term cost-effectiveness of the interventions. Trial data were used to micro-cost intervention delivery, and the data were extended to a lifetime horizon using an established Cancer Intervention Surveillance and Modeling Network lung cancer model. We modeled the impact of screening accompanied by 8-weeks vs. 3-weeks of telephone counseling (plus nicotine replacement) vs. screening alone based on 2021 screening eligibility. Lifetime downstream costs (2021 dollars) and effects (life-years gained, quality-adjusted life-years saved [QALYs]) were discounted at 3%. Sensitivity analyses tested the effects of varying quit rates and costs; all analyses assumed non-relapse after quitting. Results The costs for delivery of the 8-week vs. 3-week protocol were $380.23 vs. $144.93 per person and quit rates were 7.14% vs. 5.96%, respectively. The least costly strategy was a 3-week counseling approach. An 8-week (vs. 3-week) counseling approach increased costs but gained QALYs for an incremental cost-effectiveness ratio of $4,029 per QALY. Screening alone cost more and saved fewer QALYs than either counseling strategy. Conclusions were robust in sensitivity analyses. Conclusions Telephone-based cessation interventions with nicotine replacement are considered cost-effective in the lung screening setting. Integrating smoking cessation interventions with lung screening programs has the potential to maximize long-term health benefits at reasonable costs.

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Section: Discussioncontrasting

confidence: 65%

“…Previous economic analyses of smoking cessation interventions conducted in health care or community settings have reported costs per quit of less than $4200 ( 49–52 ). We extend these results to describing cessation intervention costs among smokers attending lung cancer screening.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting

Cao

Smith

Mandelblatt

et al. 2022

JNCI Cancer Spectrum

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“…The ICER for a tobacco cessation intervention among parents in pediatric primary care was $762 per cotinine-confirmed quit. 34 Median ICERs for cancer treatments, including colorectal cancer and hematologic cancers ranged from $22 000 to $48 000 (in 2008 US$). 32 The findings of this trial confirm and extend other trials.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Opt-out vs Opt-in Tobacco Treatment on Engagement, Cessation, and Costs

et al. 2023

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ImportanceTobacco use causes 7 million deaths per year; most national guidelines require people who use tobacco to opt in to care by affirming they are willing to quit. Use of medications and counseling is low even in advanced economy countries.ObjectiveTo evaluate the efficacy of opt-out care vs opt-in care for people who use tobacco.Design, Setting, and ParticipantsIn Changing the Default (CTD), a Bayesian adaptive population-based randomization trial, eligible patients were randomized into study groups, treated according to group assignment, and debriefed and consented for participation at 1-month follow-up. A total of 1000 adult patients were treated at a tertiary care hospital in Kansas City. Patients were randomized from September 2016 to September 2020; final follow-up was in March 2021.InterventionsAt bedside, counselors screened for eligibility, conducted baseline assessment, randomized patients to study group, and provided opt-out care or opt-in care. Counselors and medical staff provided opt-out patients with inpatient nicotine replacement therapy, prescriptions for postdischarge medications, a 2-week medication starter kit, treatment planning, and 4 outpatient counseling calls. Patients could opt out of any or all elements of care. Opt-in patients willing to quit were offered each element of treatment described previously. Opt-in patients who were unwilling to quit received motivational counseling.Main Outcomes and MeasuresThe main outcomes were biochemically verified abstinence and treatment uptake at 1 month after randomization.ResultsOf a total of 1000 eligible adult patients who were randomized, most consented and enrolled (270 [78%] of opt-in patients; 469 [73%] of opt-out patients). Adaptive randomization assigned 345 (64%) to the opt-out group and 645 (36%) to the opt-in group. The mean (SD) age at enrollment was 51.70 (14.56) for opt-out patients and 51.21 (14.80) for opt-out patients. Of 270 opt-in patients, 123 (45.56%) were female, and of 469 opt-out patients, 226 (48.19%) were female. Verified quit rates for the opt-out group vs the opt-in group were 22% vs 16% at month 1 and 19% vs 18% at 6 months. The Bayesian posterior probability that opt-out care was better than opt-in care was 0.97 at 1 month and 0.59 at 6 months. Treatment use for the opt-out group vs the opt-in group was 60% vs 34% for postdischarge cessation medication (bayesian posterior probability of 1.0), and 89% vs 37% for completing at least 1 postdischarge counseling call (bayesian posterior probability of 1.0). The incremental cost-effectiveness ratio was $678.60, representing the cost of each additional quit in the opt-out group.Conclusions and RelevanceIn this randomized clinical trial, opt-out care doubled treatment engagement and increased quit attempts, while enhancing patients’ sense of agency and alliance with practitioners. Stronger and longer treatment could increase cessation.Trial RegistrationClinicalTrials.gov Identifier: NCT02721082

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“…CEASE has been shown to be effective at helping parents quit smoking [ 10 ]. The economic evaluation of the CEASE intervention showed an incremental cost-effectiveness ratio of $1132 per quit [ 23 ]. However, less is known about the factors that influence the implementation of CEASE in pediatric office settings.…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study of Factors Influencing Implementation of Tobacco Control in Pediatric Practices

et al. 2022

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Introduction. Clinical effort against secondhand smoke exposure (CEASE) is an evidence-based intervention that prepares child healthcare clinicians and staff with the knowledge, skills, and resources needed to ask family members about tobacco use, provide brief counseling and medication assistance, and refer to free cessation services. Aim. This study sought to identify factors that influenced the implementation of CEASE in five pediatric intervention practices in five states that participated in a cluster randomized clinical trial of the CEASE intervention. Methods. Guided by questions from the consolidated framework for implementation research (CFIR) interview guide, semistructured qualitative interviews were conducted with 11 clinicians and practice staff from five intervention practices after the practices had implemented CEASE for two years. Interviews were conducted by a trained qualitative researcher, recorded with permission, and transcribed verbatim. An interview codebook was inductively developed; two researchers used the codebook to code data. After coding, data was analyzed to identify factors, as described by the CFIR domains that influenced the implementation of CEASE. Results. The implementation of CEASE in practices was influenced by the adaptability and complexity of the intervention, the needs of patients and their families, the resources available to practices to support the implementation of CEASE, other competing priorities at the practices, the cultures of practices, and clinicians’ and office staffs’ knowledge and beliefs about family-centered tobacco control. Conclusion. Identifying and influencing certain critical factors guided by information gathered through interviews may help improve implementation and sustainability of family-centered tobacco control interventions in the future. Trial Registration: ClinicalTrials.gov Identifier: NCT01882348.

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Cost-effectiveness of a Smoking Cessation Intervention for Parents in Pediatric Primary Care

Cited by 10 publications

References 18 publications

Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting

Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting

The Effects of Opt-out vs Opt-in Tobacco Treatment on Engagement, Cessation, and Costs

A Qualitative Study of Factors Influencing Implementation of Tobacco Control in Pediatric Practices

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