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 journalArticlepeer-review

3 Scopus citations


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)
Pages (from-to)2206-2216
Number of pages11
Issue number12
StatePublished - Dec 1 2019

Bibliographical note

Funding Information:
This study was funded by the National Cancer Institute (5R01CA141527), National Institutes of Health. This material is the result of work supported with resources and the use of facilities at the Minneapolis VA HSR&D Center for Care Delivery and Outcomes Research. The authors would like to gratefully acknowledge the support and assistance of Alan Rodgers and the Minnesota Department of Human Services. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.


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

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