Cost-Effectiveness of a Health System-Based Smoking Cessation Program

Area of Science:

• Public Health
• Health Economics
• Health Informatics

Background:

• Project CLIQ (Community Link to Quit) is a proactive outreach strategy using electronic health records and interactive voice recognition to connect low- to moderate-income smokers with cessation resources.
• A prior randomized trial demonstrated CLIQ's effectiveness in increasing smoking cessation rates.

Purpose of the Study:

• To evaluate the cost-effectiveness of the CLIQ system from a provider organization's perspective.
• To compare the economic impact of CLIQ against usual care for smoking cessation.

Main Methods:

• Calculated costs, cost per smoker, incremental cost per additional quit, and incremental cost per life year saved.
• Utilized data from a 2011-2013 randomized trial of the CLIQ system.
• Conducted sensitivity analyses considering economies of scale and initial versus ongoing costs.

Main Results:

• The CLIQ system cost $283,027 more than usual care over 20 months for 8544 identified smokers.
• The incremental cost per additional quit was $4137, and per life year saved was $7301.
• Sensitivity analyses indicated significant cost-effectiveness gains with increased smoker identification due to initial costs.

Conclusions:

• The CLIQ system demonstrates favorable cost-effectiveness compared to other smoking cessation interventions.
• Cost-effectiveness is maximized in health systems with high smoker populations and high participation rates.
• Widespread disseminability is achievable if health systems leverage economies of scale for this proactive tobacco treatment strategy.