COST-EFFECTIVENESS OF THE TRANSDERMAL NICOTINE PATCH AS AN ADJUNCT TOPHYSICIANS SMOKING CESSATION COUNSELING

Objective.-To determine the incremental cost-effectiveness of the tran sdermal nicotine patch. Design.-Decision analytic model that evaluated the incremental cost-effectiveness of the addition of the nicotine pa tch to smoking cessation counseling. Costs were based on physician tim e and the retail cost of the nicotine patch, and benefits were based o n quality-adjusted life years (QALYs) saved. Patients.-Male and female smokers aged 25 to 69 years receiving primary care. Intervention.-Add ition of the nicotine patch to physician-based smoking cessation couns eling. Main Outcome Measure.-Costs (1995 dollars) per QALYs saved disc ounted by 3% annually. Results.-The use of the patch produced 1 additi onal lifetime quitter at a cost of $7332. The incremental cost-effecti veness of the nicotine patch by age group ranged from $4390 to $10943 per QALY for men and $4955 to $6983 per QALY for women. A clinical str ategy involving limiting prescription renewals to patients successfull y abstaining for the first 2 weeks improved the cost-effectiveness of the patch by 25%. Conclusions.-The findings provide support both for t he routine use of the nicotine patch as an adjunct to physicians' smok ing cessation counseling and for health insurance coverage of nicotine patch therapy.