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RESEARCH PAPER
Economic evaluation of an exercise-counselling intervention to enhance smoking cessation outcomes: The Fit2Quit trial
Ralph Maddison
2,6
| 1 | University of Otago, Wellington, New Zealand |
| 2 | University of Auckland, Auckland, New Zealand |
| 3 | Berghofer Medical Research Institute, Brisbane, Australia |
| 4 | UK Centre for Tobacco Control Studies, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK |
| 5 | School of Kinesiology, Faculty of Medical and Health Sciences, University of Western Ontario, London, Canada |
| 6 | Centre for Physical Activity and Nutrition, Deakin University, Melbourne, Australia |
CORRESPONDING AUTHOR
Submission date: 2016-11-22
Acceptance date: 2017-03-20
Publication date: 2017-03-29
Tob. Induc. Dis. 2017;15(March):21
KEYWORDS
ABSTRACT
Background:
In the Fit2Quit randomised controlled trial, insufficiently-active adult cigarette smokers who contacted Quitline for support to quit smoking were randomised to usual Quitline support or to also receive ≤10 face-to-face and telephone exercise-support sessions delivered by trained exercise facilitators over the 24-week trial. This paper aims to determine the cost-effectiveness of an exercise-counselling intervention added to Quitline compared to Quitline alone in the Fit2Quit trial.
Methods:
Within-trial and lifetime cost-effectiveness were assessed. A published Markov model was adapted, with smokers facing increased risks of lung cancer and cardiovascular disease.
Results:
Over 24 weeks, the incremental programme cost per participant in the intervention was NZ$428 (US$289 or €226; purchasing power parity-adjusted [PPP]). The incremental cost-effectiveness ratio (ICER) for seven-day point prevalence measured at 24-week follow-up was NZ$31,733 (US$21,432 or €16,737 PPP-adjusted) per smoker abstaining. However, for the 52% who adhered to the intervention (≥7 contacts), the ICER for point prevalence was NZ$3,991 (US$2,695 or €2,105 PPP-adjusted). In this adherent subgroup, the Markov model estimated 0.057 and 0.068 discounted quality-adjusted life-year gains over the lifetime of 40-year-old males (ICER: NZ$4,431; US$2,993 or €2,337 PPP-adjusted) and females (ICER: NZ$2,909; US$1,965 or €1,534 PPP-adjusted).
Conclusions:
The exercise-counselling intervention will only be cost-effective if adherence is a minimum of ≥7 intervention calls, which in turn leads to a sufficient number of quitters for health gains.
Trial registration:
Australasian Clinical Trials Registry Number ACTRN12609000637246
In the Fit2Quit randomised controlled trial, insufficiently-active adult cigarette smokers who contacted Quitline for support to quit smoking were randomised to usual Quitline support or to also receive ≤10 face-to-face and telephone exercise-support sessions delivered by trained exercise facilitators over the 24-week trial. This paper aims to determine the cost-effectiveness of an exercise-counselling intervention added to Quitline compared to Quitline alone in the Fit2Quit trial.
Methods:
Within-trial and lifetime cost-effectiveness were assessed. A published Markov model was adapted, with smokers facing increased risks of lung cancer and cardiovascular disease.
Results:
Over 24 weeks, the incremental programme cost per participant in the intervention was NZ$428 (US$289 or €226; purchasing power parity-adjusted [PPP]). The incremental cost-effectiveness ratio (ICER) for seven-day point prevalence measured at 24-week follow-up was NZ$31,733 (US$21,432 or €16,737 PPP-adjusted) per smoker abstaining. However, for the 52% who adhered to the intervention (≥7 contacts), the ICER for point prevalence was NZ$3,991 (US$2,695 or €2,105 PPP-adjusted). In this adherent subgroup, the Markov model estimated 0.057 and 0.068 discounted quality-adjusted life-year gains over the lifetime of 40-year-old males (ICER: NZ$4,431; US$2,993 or €2,337 PPP-adjusted) and females (ICER: NZ$2,909; US$1,965 or €1,534 PPP-adjusted).
Conclusions:
The exercise-counselling intervention will only be cost-effective if adherence is a minimum of ≥7 intervention calls, which in turn leads to a sufficient number of quitters for health gains.
Trial registration:
Australasian Clinical Trials Registry Number ACTRN12609000637246
REFERENCES (32)
1.
Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, Wollum A, Sanman E, Wulf S, Lopez AD. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA. 2014;311(2):183–92.
2.
Braillon A. Curbing the tobacco epidemic: employing behavioral strategies or rearranging the deckchairs on the Titanic? Prev Med. 2015;73:28–9.
3.
Ussher MH, Taylor AH, Faulkner G. Exercise interventions for smoking cessation. Cochrane Database Syst Rev. 2014;8:CD002295. doi:10.1002/ 14651858.CD002295.pub5.
4.
Maddison R, Roberts V, Bullen C, McRobbie H, Jiang Y, Prapavessis H, Glover M, Taylor S, Brown P. Design and conduct of a pragmatic randomized controlled trial to enhance smoking-cessation outcomes with exercise: the Fit2Quit study. Ment Health and Phys Act. 2010;3(2):92–101.
5.
Swinburn B, Walter L, Arroll B, Tilyard M, Russell D. The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners. Am J Public Health. 1998;88(2):288–91.
6.
US Department of Health & Human Services. Physical activity and health: a report of the Surgeon General. Atlanta: U.S. Department of Health & Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996. p. 137.
7.
Maddison R, Roberts V, McRobbie H, Bullen C, Prapavessis H, Glover M, Jiang Y, Brown P, Leung W, Taylor S, et al. Exercise counseling to enhance smoking cessation outcomes: the Fit2Quit randomized controlled trial. Ann Behav Med. 2014;48(2):194–204.
8.
Craig CL, Marshall AL, Sjorstrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–95.
9.
Sullivan P, Slejko J, Sculpher M, Ghushchyan V. Catalogue of EQ-5D scores for the United Kingdom. Med Decis Mak. 2011;31(6):800–4.
10.
NZ Health Information Service. In: NZHIS, editor. National Minimum Dataset. 2006 to 2007. Wellington: New Zealand Health Information Service; 2007.
11.
Tillmann M, Silcock J. A comparison of smokers’ and ex-smokers’ healthrelated quality of life. J Public Health Med. 1997;19(3):268–73.
12.
Xie J, Wu E, Zheng Z, Croft J, Greenlund K, Mensah G, et al. Impact of stroke on health-related quality of life in the noninstitutionalized population in the United States. Stroke. 2006;37(10):2567–72.
13.
Health System Costs of Tobacco-Related Diseases [ http://www.otago.ac.nz/ wellington/departments/publichealth/research/bode3/otago075379.html ]. Accessed 23 Feb 2016.
14.
Gordon L, Hirst N, Young R, Brown P. Within a smoking-cessation program, what impact does genetic information on lung cancer need to have to demonstrate cost-effectiveness? Cost Effectiveness & Resource Allocation. 2010;8:18.
15.
Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E. Consolidated health economic evaluation reporting standards (CHEERS)—explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health. 2013;16(2):231–50.
16.
Moore SC, Lee I-M, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, Keadle SK, Arem H, de Gonzalez AB, Hartge P. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176(6):816–25.
17.
Roberts V, Dale LP, Dorey E, Bullen C, Maddison R. An exercise programme for smoking cessation: perceptions of the Fit2quit trial intervention. J Smok Cessat. 2014; FirstView:1–8.
18.
Velicer WF, Prochaska JO, Rossi JS, Snow MG. Assessing outcome in smoking cessation studies. Psychol Bull. 1992;111(1):23.
19.
Stapleton J, West R. A direct method and ICER tables for the estimation of the cost-effectiveness of smoking cessation interventions in general populations: application to a new cytisine trial and other examples. Nicotine Tob Res. 2012;14(4):463–71.
20.
Guerriero C, Cairns J, Roberts I, Rodgers A, Whittaker R, Free C. The costeffectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop. Eur J Health Econ. 2013;14(5):789–97.
21.
Hassandra M, Lintunen T, Kettunen T, Vanhala M, Toivonen H-M, Kinnunen K, Heikkinen R. Effectiveness of a mobile phone app for adults that uses physical activity as a tool to manage cigarette craving after smoking cessation: a study protocol for a randomized controlled trial. JMIR Res Protoc. 2015;4(4):e125.
22.
Whittaker R, McRobbie H, Bullen C, Borland R, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2012;11:CD006611. doi:10.1002/14651858.CD006611.pub3.
23.
Cahill K, Hartmann-Boyce J, Perera R. Incentives for smoking cessation. Cochrane Database Syst Rev. 2015;5:CD004307. doi:10.1002/14651858. CD004307.pub5.
24.
Cahill K, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database Syst Rev. 2014;2:CD003440. doi:10.1002/14651858. CD003440.pub4.
25.
Stapleton J. Cigarette smoking prevalence, cessation and relapse. Stat Methods Med Res. 1998;7:187–203.
26.
Etter J-F, Stapleton J. Nicotine replacement therapy for long-term smoking cessation: a meta-analysis. Tob Control. 2006;15:280–5.
27.
Ministry of Health. Selected cancers 2012, 2013 & 2014 (provisional). Wellington: Ministry of Health; 2015.
28.
Grey C, Wells S, Riddell T, Kerr A, Gentles D, Pylypchuk R. A comparative analysis of the cardiovascular disease risk factor profiles of Pacific peoples and Europeans living in New Zealand assessed in routine primary care: PREDICT CVD-11. N Z Med J. 2010;123(1309):62–75.
29.
Asia Pacific Cohort Studies Collaboration. Smoking, quitting, and the risk of cardiovascular disease among women and men in the Asia-Pacific region. Int J Epidemiol. 2005;34:1036–45.
30.
Marshall R, Milne R, Lynn R, Jackson R. Quantifying the effect of age on short-term and long-term case fatality in 14,000 patients with incident cases of cardiovascular disease. Eur J Cardiovasc Prev Rehabil. 2008;15(2):179–84.
31.
Statistics New Zealand. New Zealand period life tables: 2012–14. Wellington: Statistics New Zealand; 2015.
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