The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop

• Published in: The European journal of health economics Vol. 14; no. 5; pp. 789 - 797
• Main Authors: Guerriero, Carla, Cairns, John, Roberts, Ian, Rodgers, Anthony, Whittaker, Robyn, Free, Caroline
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer 01-10-2013; Springer Berlin Heidelberg; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Anti smoking movements; Cardiovascular disease; Cardiovascular diseases; Cellular telephones; Chronic obstructive pulmonary disease; Cigarette smoking; Cohort Studies; Coronary artery disease; Cost analysis; Cost efficiency; Cost estimates; Cost savings; Cost-Benefit Analysis; Economic models; Economic Policy; Economic statistics; Economic theory; Female; Financing, Personal - economics; Health behavior; Health care expenditures; Health Care Management; Health Economics; Health Status Indicators; Humans; Lung cancer; Lung neoplasms; Male; Markov Chains; Medicine; Medicine & Public Health; Middle Aged; Myocardial infarction; Original Paper; Pharmacoeconomics and Health Outcomes; Public Finance; Public Health; Quality-Adjusted Life Years; Sensitivity analysis; Sex Distribution; Smoking; Smoking Cessation; Social Support; Strokes; Studies; Text messaging; Text Messaging - economics; United Kingdom - epidemiology; United Kingdom > UK; Text message; I18; Smoking cessation aid; Economic evaluation
• ISSN: 1618-7598; 1618-7601
• DOI: 10.1007/s10198-012-0424-5

Background The txt2stop trial has shown that mobilephone-based smoking cessation support doubles biochemically validated quitting at 6 months. This study examines the cost-effectiveness of smoking cessation support delivered by mobile phone text messaging. Methods The lifetime incremental costs and benefits of adding text-based support to current practice are estimated from a UK NHS perspective using a Markov model. The cost-effectiveness was measured in terms of cost per quitter, cost per life year gained and cost per QALY gained. As in previous studies, smokers are assumed to face a higher risk of experiencing the following five diseases: lung cancer, stroke, myocardial infarction, chronic obstructive pulmonary disease, and coronary heart disease (i.e. the main fatal or disabling, but by no means the only, adverse effects of prolonged smoking). The treatment costs and health state values associated with these diseases were identified from the literature. The analysis was based on the age and gender distribution observed in the txt2stop trial. Effectiveness and cost parameters were varied in deterministic sensitivity analyses, and a probabilistic sensitivity analysis was also performed. Findings The cost of text-based support per 1,000 enrolled smokers is £16,120, which, given an estimated 58 additional quitters at 6 months, equates to £278 per quitter. However, when the future NHS costs saved (as a result of reduced smoking) are included, text-based support would be cost saving. It is estimated that 18 LYs are gained per 1,000 smokers (0.3 LYs per quitter) receiving text-based support, and 29 QALYs are gained (0.5 QALYs per quitter). The deterministic sensitivity analysis indicated that changes in individual model parameters did not alter the conclusion that this is a cost-effective intervention. Similarly, the probabilistic sensitivity analysis indicated a > 90 % chance that the intervention will be cost saving. Interpretation This study shows that under a wide variety of conditions, personalised smoking cessation advice and support by mobile phone message is both beneficial for health and cost saving to a health system.