J. Med. Internet Res. - Cost-effectiveness and cost-utility of Internet-based computer tailoring for smoking cessation.


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CKGROUND: Although effective smoking cessation interventions exist, information is limited about their cost-effectiveness and cost-utility.OBJECTIVE: To assess the cost-effectiveness and cost-utility of an Internet-based multiple computer-tailored smoking cessation program and tailored counseling by practice nurses working in Dutch general practices compared with an Internet-based multiple computer-tailored program only and care as usual.METHODS: The economic evaluation was embedded in a randomized controlled trial, for which 91 practice nurses recruited 414 eligible smokers. Smokers were randomized to receive multiple tailoring and counseling (n=163), multiple tailoring only (n=132), or usual care (n=119). Self-reported cost and quality of life were assessed during a 12-month follow-up period. Prolonged abstinence and 24-hour and 7-day point prevalence abstinence were assessed at 12-month follow-up. The trial-based economic evaluation was conducted from a societal perspective. Uncertainty was accounted for by bootstrapping (1000 times) and sensitivity analyses.RESULTS: No significant differences were found between the intervention arms with regard to baseline characteristics or effects on abstinence, quality of life, and addiction level. However, participants in the multiple tailoring and counseling group reported significantly more annual health care-related costs than participants in the usual care group. Cost-effectiveness analysis, using prolonged abstinence as the outcome measure, showed that the mere multiple computer-tailored program had the highest probability of being cost-effective. Compared with usual care, in this group ?5100 had to be paid for each additional abstinent participant. With regard to cost-utility analyses, using quality of life as the outcome measure, usual care was probably most efficient.CONCLUSIONS: To our knowledge, this was the first study to determine the cost-effectiveness and cost-utility of an Internet-based smoking cessation program with and without counseling by a practice nurse. Although the Internet-based multiple computer-tailored program seemed to be the most cost-effective treatment, the cost-utility was probably highest for care as usual. However, to ease the interpretation of cost-effectiveness results, future research should aim at identifying an acceptable cutoff point for the willingness to pay per abstinent participant.

Resumo Limpo

ckground although effect smoke cessat intervent exist inform limit costeffect costutilityobject assess costeffect costutil internetbas multipl computertailor smoke cessat program tailor counsel practic nurs work dutch general practic compar internetbas multipl computertailor program care usualmethod econom evalu embed random control trial practic nurs recruit elig smoker smoker random receiv multipl tailor counsel n multipl tailor n usual care n selfreport cost qualiti life assess month followup period prolong abstin hour day point preval abstin assess month followup trialbas econom evalu conduct societ perspect uncertainti account bootstrap time sensit analysesresult signific differ found intervent arm regard baselin characterist effect abstin qualiti life addict level howev particip multipl tailor counsel group report signific annual health carerel cost particip usual care group costeffect analysi use prolong abstin outcom measur show mere multipl computertailor program highest probabl costeffect compar usual care group paid addit abstin particip regard costutil analys use qualiti life outcom measur usual care probabl efficientconclus knowledg first studi determin costeffect costutil internetbas smoke cessat program without counsel practic nurs although internetbas multipl computertailor program seem costeffect treatment costutil probabl highest care usual howev eas interpret costeffect result futur research aim identifi accept cutoff point willing pay per abstin particip

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