Cost-Effectiveness of Smoking-Cessation Approaches in Emergency Departments

Authors

Ted R. Miller, Pacific Institute for Research and Evaluation, Beltsville, Maryland, School of Public Health, Curtin University, Perth, Australia. Electronic address: miller@pire.org.
Mark B. Johnson, Pacific Institute for Research and Evaluation, Beltsville, Maryland, School of Public Health, Curtin University, Perth, Australia.
James D. Dziura, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
June Weiss, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
Kelly M. Carpenter, Optum Center for Wellbeing Research, Seattle, Washington.
Lauretta E. Grau, Yale Center for Implementation Science, Yale School of Medicine, New Haven, Connecticut.
Michael V. Pantalon, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
Lorien Abroms, Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia.
Linda M. Collins, School of Global Public Health, New York University, New Haven, Connecticut.
Benjamin A. Toll, Yale Cancer Center, New Haven, Connecticut; Medical University of South Carolina, Charleston, South Carolina.
Steven L. Bernstein, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth Geisel School of Medicine, Hanover, New Hampshire; C. Everett Koop Institute at Dartmouth, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.

Document Type

Journal Article

Publication Date

1-27-2023

Journal

American journal of preventive medicine

DOI

10.1016/j.amepre.2023.01.006

Abstract

INTRODUCTION: Americans of lower SES use tobacco products at disproportionately high rates and are over-represented as patients of emergency departments. Accordingly, emergency department visits are an ideal time to initiate tobacco treatment and aftercare for this vulnerable and understudied population. This research estimates the costs per quit of emergency department smoking-cessation interventions and compares them with those of other approaches. METHODS: Previously published research described the effectiveness of 2 multicomponent smoking-cessation interventions, including brief negotiated interviewing, nicotine replacement therapy, quitline referral, and follow-up communication. Study 1 (collected in 2010-2012) only analyzed the combined interventions. Study 2 (collected in 2017-2019) analyzed the intervention components independently. Costs per participant and per quit were estimated separately, under distinct intervention with dedicated staff and intervention with repurposed staff assumptions. The distinction concerns whether the intervention used dedicated staff for delivery or whether time from existing staff was repurposed for intervention if available. RESULTS: Data were analyzed in 2021-2022. In the first study, the cost per participant was $860 (2018 dollars), and the cost per quit was $11,814 (95% CI=$7,641, $25,423) (dedicated) and $227 per participant and $3,121 per quit (95% CI=$1,910, $7,012) (repurposed). In Study 2, the combined effect of brief negotiated interviewing, nicotine replacement therapy, and quitline cost $808 per participant and $6,100 per quit (dedicated) (95% CI=$4,043, $12,274) and $221 per participant and $1,669 per quit (95% CI=$1,052, $3,531) (repurposed). CONCLUSIONS: Costs varied considerably per method used but were comparable with those of other smoking-cessation interventions.

APA Citation

Miller, Ted R.; Johnson, Mark B.; Dziura, James D.; Weiss, June; Carpenter, Kelly M.; Grau, Lauretta E.; Pantalon, Michael V.; Abroms, Lorien; Collins, Linda M.; Toll, Benjamin A.; and Bernstein, Steven L., "Cost-Effectiveness of Smoking-Cessation Approaches in Emergency Departments" (2023). GW Authored Works. Paper 2228.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2228

Department

Prevention and Community Health