This study aimed to compare the cost-effectiveness estimates of a brief counselling of smoking cessation in dentistry by using two different health economic models.
Design and outcome measuresIntervention effectiveness was estimated in a cluster randomised controlled trial. The number of quitters was estimated based on 7-day abstinence and on smoking reduction at follow-up. Health economic evaluation was performed using two models: (1) a population-based model employing potential impact fractions and (2) a Markov model estimating the cost-effectiveness of the intervention for the actual participants. The evaluation was performed from healthcare and societal perspectives, and health gains were expressed in quality-adjusted life-years (QALYs).
SettingDental clinics in Sweden.
Participants205 Swedish smokers aged 20–75 years.
InterventionsA brief, structured behavioural intervention was compared with ‘usual care’.
ResultsThe cost per quitter was US$552 in the intervention and US$522 in the ‘usual care’ condition. The net saving estimated with the population-based model was US$17.3 million for intervention and US$49.9 million for ‘usual care’, with health gains of 1428 QALYs and 2369 QALYs, respectively, for the whole Swedish population during 10 years. The intervention was thus dominated by ‘usual care’. The reverse was true when using the Markov model, showing net societal savings of US$71 000 for the intervention and US$57000 for ‘usual care’, with gains of 5.42 QALYs and 4.74 QALYs, respectively, for lifelong quitters.
ConclusionThe comparison of intervention and ‘usual care’ derived from small-scale studies may be highly sensitive to the choice of the model used to calculate cost-effectiveness.
Trial registrationThe cluster randomised trial is registered in the ISRCTN register of controlled trials with identification number ISRCTN50627997.
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