COST-EFFECTIVENESS OF TREATING NICOTINE DEPENDENCE - THE MAYO-CLINIC EXPERIENCE

Objective: To estimate the cost-effectiveness of treating nicotine dep endence, expressed as cost per net year of life gained by smoking cess ation. Design: A cost-effectiveness analysis was conducted of a cohort of consecutive adult patients treated for nicotine dependence from Ap ril 1988 through December 1992 at the Mayo Clinic Nicotine Dependence Center (NDC). Material and Methods: The study cohort consisted of 5,54 4 patients (50.8% female; mean age, 47.8 years) with a mean baseline s moking rate of 25.4 cigarettes per day. After an initial consultation, a nonphysician counselor developed an individual nicotine dependence treatment plan, which could include follow-up counseling, nicotine rep lacement therapy (patches or gum), group therapy, or an inpatient prog ram. A relapse-prevention program included telephone calls and a serie s of letters to the patient. We computed the years of life gained for each person specific to age, gender, smoking rate at entry, and 6-mont h smoking status by using published mortality rates for current and fo rmer cigarette smokers. The 6-month smoking status was assumed to be a pplicable at 1 year. For subsequent determinations, we modeled by comp uter simulation the year-by-year (to age 100) smoking status by using published relapse and late cessation rates. Coupled with treatment cos ts, this information allowed the expression of cost per net year of li fe gained by stopping smoking. Net years of life gained, discounted 0, 3, and 5%, were computed with use of cessation and relapse rates expe cted for patients not seen in the NDC. Treatment costs were based on 1 993 rates for the intervention services but did not include any tobacc o product cost savings associated with smoking cessation. Results: The 1-year smoking-cessation rate was 22.2%. With all NDC patients includ ed, the estimated net years of life gained, with use of a 5% rate of d iscount for benefits, was 0.058, and the corresponding cost was $6,828 per net year of life gained. Conclusion: In comparison with the cost- effectiveness of other medical services, the cost of $6,828 per net ye ar of life gained by treatment of nicotine dependence is relatively in expensive. Such cost-outcome data are important as economic considerat ions are applied for optimal allocation of limited healthcare resource s. Nonphysician health-care professionals can assume a key role in the provision of cost-effective nicotine dependence intervention.