Smoking Cessation Programs: An Economic Evaluation - Research Paper Example

Smoking Cessation Programs: An Economic Evaluation Smoking Cessation Programs: An Economic Evaluation Introduction Tobacco cessation is one of the top three priorities available for potential health benefit, improved outcomes and cost. Though most smoking cessation programs are expensive, they also prove to be cost-effective. In the past, smoking cessation programs have been targeted at large groups of people with little improved outcome and not being very cost effective. However, more concentrated efforts on smaller groups prove to be much more effective and therefore more cost effective (Barnett, Wong, & Hall, 2008). This paper will briefly review the issue of healthcare economics and then apply that information to smoking cessation as an economically based study with cost efficient outcomes. Health Care Economics The economic evaluation of healthcare has become a major new career throughout the world. However, many of the most sophisticated of those studies are presently being done in the UK (Fattore & Torbica, 2006). The study done by Fattore and Torbica (2006) consisted for a thorough research of how an economic study is done and how those results are presently being used. This study used information gotten from survey of Health Care Management Executives and presented information on the correct way to carry out an economically based healthcare study. This paper will incorporate some of these and other techniques learned. Smoking as the Problem Even though smoking has been banned in public places in the UK for some time, the annual cost of smoking in the NHS has essentially doubled (Hays, 2008). Research done by Action on Smoking and the British Heart Foundation and Cancer Research UK (2008) has concluded that the cost would have risen even more if the government had not acted and some social pressure had not come to bear. The total number of smokers has decreased from a little over 12 million to 9 million over these last few years. It is believed that if the UK designs and implements a strong tobacco control strategy that it will lead to another reduction of 4.5 million smokers (Brit, 2008). Morbidity caused by smoking is one of the most preventable causes and costs in the world today. Smoking has cost, from 2000-2004, some 4,443,595 deaths at a cost of $193 billion per year in productivity (Hays, 2008). This is just lost income for companies from sick employees. However, there are certainly other human costs. Those include COPD, cancer, long term poverty created from inability to work, and the effects of second hand smoke on those around them. The list could go on and on. This habit is extremely costly, not only to the government, but to healthcare in general in a time when healthcare has to reduce costs in order to survive. Evaluation of the Research Starkey, Moore, Campbell, Sidaway, and Bloor (2005) studied a cost effective program that was peer led in the schools in the UK. Smoking in the ages of 11-16 in the UK had not improved with previous programs. The average rate of smokers in this age group was around 10%(Starkey et al, 2005). The goal of the British Government is to reduce that rate to 9% by 2010. It has been unclear how to make that happen. It was determined by Starkey et al (2005) that many of the programs thus far developed were school based run by the school themselves. They felt that a program that as peer based might bring better outcomes and may, in fact, do that at a lower cost. ASSIST got involved in the study. This became a large comprehensive study. They used a randomized controlled design for the study. The included a detailed process evaluation, an economic evaluation, and an analysis of social networks enabling the team to answer questions that stemmed beyond the effectiveness of this study (2005). Peer between the ages of 11 and 16 were trained to use social contact to encourage their peers to quit smoking. Student was nominated for this honor as students who were influential and then they were invited to train. They were given skills in peer support, health economics, and training in the social and environmental risks of smoking. This study was then initiated in random schools and a two year study period was chosen. There were a total of 59 schools in the baseline data collection with a mean size of 187 students. 39.6 per cent of the students were considered at risk because they had either tried or were using cigarettes. Outcomes showed 73% of students at risk showed not smoking (salivary tests were done) one year after the completed study. This is a major improvement, not only in cost but in lives as this age group will affect the UK healthcare for many Years (Starkey et al, 2005). Johansson, Tillgre, Guldbransson & Lars (2004) presents us with little different study that is worth examining. Most programs on smoking cessation have been evaluated but not under the economic principles for healthcare. Good economic principles would give us data that is spelled out mostly in life years saved per quitter which gives a standard to base the efficiency of this program. We must become better at doing this as there are not unlimited funds out there to put into health care prevention. Therefore we must determine what proportion of those funds should go toward cessation of smoking (Johnsson et al, 2004). The goal of this study was to develop a good cost-effective analysis tool. “The model was designed to use primary data on medical treatment costs and quality of life weights” (Johnsson, 2004) .The model, stochastic, simulates the effect of tobacco cessation on such problems of lung cancer, chronic pulmonary disease, and cardiovascular disease. The model only terminates at death or 85 years old. The results showed an extremely high cost to the healthcare system for those patients that smoked. Those costs were attributed to COPD, AMI, MI, CHF, Angina, and Stroke. The numbers of study participants that actually had at least one of these related diseases by the end of the study averaged 70% in the smoking group. The costs ran upward of 180,000SEK per patient for the lifetime of their disease. The intervention was applied to the second group. That intervention was the Quit and Win program. In this program there was a second program called Quit Smoking Galls which put together and use in the healthcare districts of Stockholm (Johnsson, 2004). This included 18,000 women and children. 23% were daily smokers. To be eligible for the prize, the smoker had to be smoke free for 7 months. Nicotine replacement products were allowed. The quitters were defined as being tobacco free for 12 months. 238 women participated in the program and 14% were certified tobacco free. The cost of the program was 267,000SEK. This included all costs. The cost as noted prior was 180,000 per person who smoked. The cost savings are then tremendous. It cost a total of 267,000SSK for the program and saved healthcare costs are 5,940,000SK (Burnett, et al. 2008). Recommendation Smoking cessation, when studied from the healthcare economics perspective, is much more cost effective than most other medical care interventions. The size of the pool of participants coupled with the disease states created by this habit creates a large savings for only turning small numbers away from smoking. We may very well have tried to make our efforts to big, however. It appears through the studies that we have noted that smaller groups work better. This writer’s recommendation, after review has to revolve around something similar to the Stockholm study with groups like the UK study. In other words the use of winning a prize in school groups in the UK. This writer would recommend this means for several reasons. First, picking small groups to work with seems to provide the best outcomes according to the studies reviewed. Since we do not have unlimited access to funds we want to assure that those funds are well spent. Second, the people who will impact the costs in the health system the greatest are now the youngest as there is more time for them to develop the disease states and be treated over a longer period of time. This would make my final recommendation for the best outcomes, to take the funds presently available and spend them in motivated programs run with prizes by peers in the UK school system. Conclusion Smoking is a devastating habit that creates long term health effects for the smoker. However, it also affects the costs of healthcare throughout the world as well as the cost to many companies. The costs to healthcare, of course, include those of long term diseases such as cancer, chronic lung disease, and circulatory issues. The cost to companies includes lost time at work and low productivity. Many smoking cessation programs have not worked and when comparison costs are done the outcomes are poor. However, there are at least a couple of studies showing that there is the ability to get long term results at a reasonable cost. Certainly because of the size of the problem, good outcomes calculate to tremendous healthcare savings. Fore these reasons continued effort is important and the use of studies that prove too effective is especially necessary to reduce the over all time needed to produce those outcomes. We must solve this problem for the good of us all. Bibliography Burnett, P., Wong, W., & Hall, S., 2008. The cost-effectiveness of a smoking cessation program for out-patients in treatment for depression. Society for the Study of Addiction. 103. pgs 834-840 Byford, S., McDaid, D., & Sefton, T. 2003. Because it’s worth it: A practical guide to conducting economic evaluations in the social welfare field. Institute of Psychiatry. 2 (231). Fattore, G., & Torbica, A. 2006) Economic evaluation in health care: the point of view of informed physicians. International Society for Pharmacoeconomics and Outcomes Research 9 (3). Pgs 157-167. Grandes, F., Cortada, J.M., and Arrazola, A. 2000. An evidence-based program for smoking cessation: effectiveness in routine general practice. British Journal of General Practice. 50(459): pgs 803-807. Hays, J.T. Ebbert, J.G. & Sood, A. 2009 Treating tobacco dependence in light of the 2008 U.S.Department of health & human services clinical practice guidelines. Mayo Clinic Proceedings (MAYO Clin Proc) 84 (8) 730-6. Johansson, P., Tillgren, P., Guldbrandsson, K., & Lindholm, L. 2005. A model for cost-effectiveness analyses of smoking cessation interventions applied to a Quit-and-Win contest for mothers of small children. Scandinavian Journal of Public Health. 33. pgs 343-352. Napper, M., & Varney, J., Health Economics Information. 2002. Available at http://www.nim.gov/archive//2060905/nichsr/ehta/chapter11.html Smoking still costs NHS pounds a year in England. Occupational Health, 2008. 60 (11) pp. 293-314. Starkey, F., Moore, L., Campbell, R., Sidaway, M., and Bloor, M. 2005 Rationale, design and conduct of a comprehensive evaluation of a school based peer led anti-smoking intervention in the UK; the ASSIST cluster randomized trial. BMC Public Health. This article is available at http://www.biomedcentrol.com Appendix Literature Review The overall method used for literature review was from the broad to the narrow. This paper initially explored the use of economics in the healthcare arena and searched under healthcare economics. Information found here included Fattore et al (2006) and the Economic evaluation in health care: the point of view of the informed physician. This article investigates the overall background in healthcare management and economics that the average physician might have. This study was done through questionnaire and survey. We have to also include Byford’s, Because it’s worth it article on conducting a practice economic evaluation in the social welfare field. It was interesting in the sense that it raised questions as to how well we can document outcomes. Continuing in that manner, Framing an economic evaluation by the CDC and Measuring cost effectiveness by the DEM were reviewed. These were general articles on health economics and outcomes measurement. Though the articles were reviewed, the information did not seem very pertinent to our paper. Naper’s presentation of the article for Health Economics is the same. It is good information but contains too many holes in the information for our purposes. Becoming more specific in the search brought Grandes et al and An Evidence-Based Program for Smoking Cessation. This article gave good information on the evidence based protocols of today and how those might be incorporated in the overall scheme of an economics study of smoking cessation. Using key words of smoking, cessation, study two very good articles on two excellent studies were found. This research was excellent and provided the meat of the information in this study. Barnett et al’s study (2008), The cost- effectiveness of a smoking cessation program for out-patients in treatment for depression was excellent. This was a well run study that gave us excellent statistical information as well as design information on a study. Starkey et al. (2005) was specific to the UK and how the studies are being handles there as well as how those costs are being calculated. This study was excellent in helping us understand how to perform the study and how to calculate the results. Read More