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Cost-effectiveness of enhancing a Quit-and-Win smoking cessation program for college students

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Abstract

Objectives

We conducted a cost-effectiveness analysis and model-based cost–utility and cost–benefit analysis of increased dosage (3 vs. 1 consecutive contests) and enhanced content (supplemental smoking-cessation counseling) of the Quit-and-Win contest using data from a randomized control trial enrolling college students in the US.

Methods

For the cost–utility and cost–benefit analyses, we used a microsimulation model of the life course of current and former smokers to translate the distribution of the duration of continuous abstinence among each treatment arm’s participants observed at the end of the trial (N = 1217) into expected quality-adjusted life-years (QALYs) and costs and an incremental net monetary benefit (INMB). Missing observations in the trial were classified as smoking. For our reference case, we took a societal perspective and used a 3% discount rate for costs and benefits. A probabilistic sensitivity analysis (PSA) was performed to account for model and trial-estimated parameter uncertainty. We also conducted a cost-effectiveness analysis (cost per additional intermediate cessation) using direct costs of the intervention and two trial-based estimates of intermediate cessation: (a) biochemically verified (BV) 6-month continuous abstinence and (b) BV 30-day point prevalence abstinence at 6 months.

Results

Multiple contests resulted in a significantly higher BV 6-month continuous abstinence rate (RD 0.04), at a cost of $1275 per additional quit, and increased the duration of continuous abstinence among quitters. In the long run, multiple contests lead to an average gain of 0.03 QALYs and were cost saving. Incorporating parameter uncertainty into the analyses, the expected INMB was greater than $1000 for any realistic willingness to pay (WTP) for a QALY.

Conclusions

Assuming missing values were smoking, multiple contests appear to dominate a single contest from a societal perspective. Funding agencies seeking to promote population health by funding a Quit-and-Win contest in a university setting should strongly consider offering multiple consecutive contests. Further research is needed to evaluate multiple contests compared to no contest.

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Notes

  1. Health-related quality of life measures (derived from the EuroQol 5-item and a self-reported General Health Status) were available for trial participants at baseline and 6 months. However, we found no difference across arms and comparing quitters to non-quitters. We, therefore, do not discuss them.

  2. We could not find these values for a US population.

  3. The justification for this is given below.

  4. The sample size for each of the four treatment arms was as follows. Single Contest Arm = 306; Single Contest + Counseling Arm = 296; Multiple Contest Arm = 309; Multiple Contest + Counseling Arm = 306.

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Funding

This study was funded by the National Heart, Lung, and Blood Institute (5R01-HL094183-05, Thomas, PI). The parent trial is registered with Clinical Trials.Gov, NCT01096108.

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Authors and Affiliations

  1. Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware Street SE, MMC 729, Minneapolis, MN, 55414, USA

    Jonah Popp & John A. Nyman

  2. Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Xianghua Luo

  3. Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA

    Xianghua Luo

  4. Division of General Internal Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Jill Bengtson & Janet L. Thomas

  5. Boynton Health Service, University of Minnesota, Minneapolis, MN, USA

    Katherine Lust

  6. Center for Health Communications Research, University of Michigan, Ann Arbor, MI, USA

    Lawrence An

  7. Brown University, Providence, RI, USA

    Jasjit S. Ahluwalia

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  1. Jonah Popp
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Correspondence to Jonah Popp.

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The trial was approved by the University of Minnesota Human Subjects Committee. See primary publication [10] for details.

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Popp, J., Nyman, J.A., Luo, X. et al. Cost-effectiveness of enhancing a Quit-and-Win smoking cessation program for college students. Eur J Health Econ 19, 1319–1333 (2018). https://doi.org/10.1007/s10198-018-0977-z

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  • DOI: https://doi.org/10.1007/s10198-018-0977-z

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