The cost-effectiveness of the English smoking treatment services: evidence from practice.

AIMS To investigate the cost-effectiveness of English specialist smoking cessation services. DESIGN Combination of observational cost and outcome data from English smoking cessation services to calculate cost-effectiveness ratios. Multivariate analysis of factors influencing variation in services' cost-effectiveness. SETTING Fifty-eight of the 92 specialist smoking cessation services in England in 2000/01. METHODS Services' costs were estimated using survey data which described services' configurations, staffing, interventions delivered and development. Information on services' throughput and outcomes (as biochemically validated 4-week smoking cessation rates) were obtained from routine sources. With reference to relevant literature and assumptions about relapse and background cessation rates, 4-week cessation rates were converted first to 1-year rates. One-year cessation rates were adjusted to reflect the likely permanent smoking cessation rate attributable to service intervention and finally attributable life-years gained were calculated. A wide variety of sensitivity analyses was performed to test the robustness of the average cost-effectiveness ratio, calculated by combining the cost and life-year gained estimates, for all services. With additional data on deprivation levels in services' areas, ordinary least-squares regression techniques were used to investigate variations in individual services' costs per client and cost-effectiveness ratios. FINDINGS Using an up-to-date estimate for health gain accrued by stopping smoking, the average cost per life gained was pound 684 (95% CI 557811), falling to pound 438 when savings in future health-care costs were counted. With the worst case assumptions, the estimate of cost-effectiveness rose to pound 2693 per life-year saved (pound 2293 including future health-care costs) and fell to pound 227 (pound 102) under the most favourable assumptions. Findings are comparable to previous published studies. The regression results suggest that different factors influence cost per client and the net cost per life-year saved, indicating that decision makers should be careful in setting performance targets for these services. CONCLUSIONS In 2000/01, English smoking cessation services provided cost-effective services operating well below the benchmark of pound 20,000 per quality-adjusted life-year saved (QALY) that is used by the National Institute for Clinical Excellence in the United Kingdom.