The authors of this Dutch study sought to estimate the impact of smoking cessation interventions for patients with COPD on the future burden of their disease.  They note that little is known about the cost-effectiveness of smoking cessation interventions offered to those who already have a smoking related disease such as COPD; and what is available relates to the short-term. 

Researchers conducted a systematic review and located nine randomised controlled trials (RCTs) of smoking cessation interventions in patients with COPD that reported validated 12-month abstinence rates.  Interventions were grouped into categories and the average continuous abstinence rate at 12 months for each was estimated. 

A previously published dynamic population-based model of COPD disease progression was then used to project the long-term cost-effectiveness compared with usual care, based on implementation for one year in 50% of the patients with COPD who smoked (i.e. the reported percentage of patients with COPD who smoke reporting a willingness to stop smoking within 6 months).  The effects of smoking cessation were modelled as a one-time increase in FEV1 followed by a lower annual decline based on the results of the Lung Health Study, and reduced mortality due to COPD and other smoking-related diseases. 

Sensitivity analyses were performed for variations in the calculation of the abstinence rates, the type of projection, intervention costs and discount rates.

The main findings were as follows:

• The average 12-month continuous abstinence rates were estimated to be 1.4% for usual care (no counselling or pharmacotherapy, or any intervention for smoking cessation) 2.6% for minimal counselling (<90 minutes in total), 6.0% for intensive counselling (≥90 minutes without pharmacotherapy) and 12.3% for pharmacotherapy.

• Compared with usual care, the costs per quality-adjusted life year (QALY) gained for minimal counselling, intensive counselling and pharmacotherapy were €16,900, €8200 and €2400, respectively. The results were most sensitive to variations in the estimation of the abstinence rates and discount rates.

Conclusion Compared with usual care, intensive counselling and pharmacotherapy resulted in low costs per QALY gained with ratios comparable to results for smoking cessation in the general population. Compared with intensive counselling, pharmacotherapy was cost saving and dominated the other interventions.

The authors conclude that their results “confirm the advice given in the guidelines that patients with COPD should be offered the most intensive smoking cessation intervention feasible, not only from a clinical but also from an economic perspective.”