Cost‐effectiveness of personal tailored risk information and taster sessions to increase the uptake of the NHS stop smoking services: the Start2quit randomized controlled trial

Abstract

AimsTo assess the cost‐effectiveness of a two‐component intervention designed to increase attendance at the NHS Stop Smoking Services (SSSs) in England.DesignCost‐effectiveness analysis alongside a randomized controlled trial (Start2quit).SettingNHS SSS and general practices in England.ParticipantsThe study comprised 4384 smokers aged 16 years or more identified from medical records in 99 participating practices, who were motivated to quit and had not attended the SSS in the previous 12 months.Intervention and comparatorIntervention was a personalized and tailored letter sent from the general practitioner (GP) and a personal invitation and appointment to attend a taster session providing information about SSS. Control was a standard generic letter from the GP advertising SSS and asking smokers to contact the service to make an appointment.MeasurementsCosts measured from an NHS/personal social services perspective, estimated health gains in quality‐adjusted life‐years (QALYs) measured with EQ‐5D and incremental cost per QALY gained during both 6 months and a life‐time horizon.FindingsDuring the trial period, the adjusted mean difference in costs was £92 [95% confidence interval (CI) = –£32 to –£216) and the adjusted mean difference in QALY gains was 0.002 (95% CI = –0.001 to 0.004). This generates an incremental cost per QALY gained of £59 401. The probability that the tailored letter and taster session is more cost‐effective than the generic letter at 6 months is never above 50%. In contrast, the discounted life‐time health‐care cost was lower in the intervention group, while the life‐time QALY gains were significantly higher. The probability that the intervention is more cost‐effective is more than 83% using a £20 000–30 000 per QALY‐gained decision‐making threshold.ConclusionsAn intervention designed to increase attendance at the NHS Stop Smoking Services (tailored letter and taster session in the services) appears less likely to be cost‐effective than a generic letter in the short term, but is likely to become more cost‐effective than the generic letter during the long term.

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“…Prior research has emphasized this; personalized information is rated positively by both patients and professionals and the uptake of the innovation improves when the letter is added to the electronic patient files [ 49 ]. Apart from this, personalized information in general has proven to be cost-effective in the long run [ 50 ].…”

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“…The cost associated with the brief intervention we evaluated (estimated to be £55.77 for each person attending stop smoking clinic) was similar to that estimated in an evaluation by Wu et al of a personalised invitation from primary care to stop smoking clinic and appointment for a taster session, with an estimated mean cost of £54 per person. This was found to be cost-effective from an NHS perspective in the long-term 18. Although few studies have comprehensively evaluated the economic impact of smoking cessation across a lifetime, available data suggest that there may be net savings from investing in smoking cessation 19.…”