Cost-effectiveness of population-level proactive tobacco cessation outreach among socio-economically disadvantaged smokers: evaluation of a randomized control trial

Viengneesee Thao, John A. Nyman, David B Nelson, Anne M Joseph, Barbara Clothier, Patrick J. Hammett, Steven S Fu

Research output: Contribution to journalArticle

Abstract

Aims: To estimate the cost-effectiveness at population-level of the OPT-IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low-income persons (e.g. Medicaid). Design: Cost-effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT-IN) randomized control trial. Setting: The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective. Participants: Data were used from 2406 smokers who were randomized into the intervention or comparator groups. Intervention and comparator: The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)-approved smoking cessation medications and the state's telephone quitline. Measurements: Smoking status, quality of life and health-care use at varying times, including at baseline and 1 year. Findings: The OPT-IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population-level, 6-month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life-time cost and generated 0.005 additional quality-adjusted life-years (QALYs), with an expected incremental cost-effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost-effective against a willingness-to-pay threshold of $50 000/QALY approximately 68% of the time. Conclusions: Population-level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population-level quit rates and was cost-effective at various willingness-to-pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population-level proactive tobacco cessation outreach programs are judged to be highly cost-effective over the long term.

Original languageEnglish (US)
JournalAddiction
DOIs
StateAccepted/In press - Jan 1 2019

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Tobacco Use Cessation
Vulnerable Populations
Cost-Benefit Analysis
Telephone
Quality-Adjusted Life Years
Costs and Cost Analysis
Population
Medicaid
Therapeutics
Smoking
Withholding Treatment
Insurance Coverage
Quality of Health Care
Primary Care Physicians
Smoking Cessation
United States Food and Drug Administration
Health Insurance
Random Allocation
Nicotine
Tobacco

Keywords

  • Cost-effectiveness
  • Markov model
  • health-care disparities
  • low-income population
  • proactive outreach
  • smoking cessation

PubMed: MeSH publication types

  • Journal Article

Cite this

@article{0fc5aaa6951f4820a5b18cd20524fdd6,
title = "Cost-effectiveness of population-level proactive tobacco cessation outreach among socio-economically disadvantaged smokers: evaluation of a randomized control trial",
abstract = "Aims: To estimate the cost-effectiveness at population-level of the OPT-IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low-income persons (e.g. Medicaid). Design: Cost-effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT-IN) randomized control trial. Setting: The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective. Participants: Data were used from 2406 smokers who were randomized into the intervention or comparator groups. Intervention and comparator: The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)-approved smoking cessation medications and the state's telephone quitline. Measurements: Smoking status, quality of life and health-care use at varying times, including at baseline and 1 year. Findings: The OPT-IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population-level, 6-month prolonged smoking abstinence rate was 16.5{\%} in the proactive outreach intervention group and 12.1{\%} in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life-time cost and generated 0.005 additional quality-adjusted life-years (QALYs), with an expected incremental cost-effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost-effective against a willingness-to-pay threshold of $50 000/QALY approximately 68{\%} of the time. Conclusions: Population-level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population-level quit rates and was cost-effective at various willingness-to-pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population-level proactive tobacco cessation outreach programs are judged to be highly cost-effective over the long term.",
keywords = "Cost-effectiveness, Markov model, health-care disparities, low-income population, proactive outreach, smoking cessation",
author = "Viengneesee Thao and Nyman, {John A.} and Nelson, {David B} and Joseph, {Anne M} and Barbara Clothier and Hammett, {Patrick J.} and Fu, {Steven S}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/add.14752",
language = "English (US)",
journal = "Addiction",
issn = "0965-2140",
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TY - JOUR

T1 - Cost-effectiveness of population-level proactive tobacco cessation outreach among socio-economically disadvantaged smokers

T2 - evaluation of a randomized control trial

AU - Thao, Viengneesee

AU - Nyman, John A.

AU - Nelson, David B

AU - Joseph, Anne M

AU - Clothier, Barbara

AU - Hammett, Patrick J.

AU - Fu, Steven S

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: To estimate the cost-effectiveness at population-level of the OPT-IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low-income persons (e.g. Medicaid). Design: Cost-effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT-IN) randomized control trial. Setting: The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective. Participants: Data were used from 2406 smokers who were randomized into the intervention or comparator groups. Intervention and comparator: The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)-approved smoking cessation medications and the state's telephone quitline. Measurements: Smoking status, quality of life and health-care use at varying times, including at baseline and 1 year. Findings: The OPT-IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population-level, 6-month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life-time cost and generated 0.005 additional quality-adjusted life-years (QALYs), with an expected incremental cost-effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost-effective against a willingness-to-pay threshold of $50 000/QALY approximately 68% of the time. Conclusions: Population-level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population-level quit rates and was cost-effective at various willingness-to-pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population-level proactive tobacco cessation outreach programs are judged to be highly cost-effective over the long term.

AB - Aims: To estimate the cost-effectiveness at population-level of the OPT-IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low-income persons (e.g. Medicaid). Design: Cost-effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT-IN) randomized control trial. Setting: The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective. Participants: Data were used from 2406 smokers who were randomized into the intervention or comparator groups. Intervention and comparator: The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)-approved smoking cessation medications and the state's telephone quitline. Measurements: Smoking status, quality of life and health-care use at varying times, including at baseline and 1 year. Findings: The OPT-IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population-level, 6-month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life-time cost and generated 0.005 additional quality-adjusted life-years (QALYs), with an expected incremental cost-effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost-effective against a willingness-to-pay threshold of $50 000/QALY approximately 68% of the time. Conclusions: Population-level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population-level quit rates and was cost-effective at various willingness-to-pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population-level proactive tobacco cessation outreach programs are judged to be highly cost-effective over the long term.

KW - Cost-effectiveness

KW - Markov model

KW - health-care disparities

KW - low-income population

KW - proactive outreach

KW - smoking cessation

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