Estimating the Short-term Clinical and Economic Benefits of Smoking Cessation: Do We Have it Right?

Joseph Menzin; Lisa M Lines; Jeno Marton

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(3):257-264. 

In This Article

Expert Commentary

The two main questions that remain to be adequately answered by studies conducted to date include: does smoking cessation result in short-term savings in direct costs and what are the effects of smoking cessation on work productivity? The question of direct cost savings is tricky because of the spike in healthcare utilization that is often seen among recent quitters. In addition, older ex-smokers and never smokers accrue greater lifetime healthcare costs than smokers do. Costs are greatest in old age, an age that many smokers do not reach because of smoking-related mortality.

There is some debate among health economists over whether unrelated costs accrued during additional years of life should be included when calculating cost-effectiveness, particularly for primary preventions, such as smoking cessation.[64] For example, if a person stops smoking and, thereby, extends his or her life through prevention of a CHD event, the cost savings from the reduced incidence in CHD events is obviously related and should be included. However, what if that person develops arthritis later in life? Should the costs involved in treating arthritis be subtracted from the cost savings arising from prevention of a CHD event? Regardless of which specific future costs are included, incorporating them will make preventive strategies less cost effective than they would be otherwise and potentially bias comparisons of the economic value of preventative versus therapeutic interventions in clinical medicine.[65]

The question of the effects of smoking cessation on productivity is especially relevant to employers, who incur indirect costs from smoking because of workplace absenteeism and productivity loss. In one of the few studies of absenteeism and the indirect costs of smoking, quitters were shown to have absenteeism rates between those of never smokers and continuing smokers.[37] Absenteeism continued to decline in the years after smoking cessation and the workplace productivity of quitters returned to that of a never smoker in 1-4 years.[37] Additional well-designed studies of the indirect costs of smoking are urgently needed.

Some of the studies discussed in this review could be used in models to better understand the value of smoking cessation over the short term. Existing economic models have a few shortcomings, most notably a lack of good data on the short-term effects of smoking cessation on absenteeism and workplace productivity. In addition, existing studies have frequently been too short to see clear benefits. Few researchers have adequately compared different populations of quitters, such as younger versus older and healthier versus sicker populations. More-creative thinking may be needed in order to build more accurate models of smoking cessation. The main gaps we have identified are in the areas of productivity and absenteeism and the need to control for bias in direct cost assessment related to smoking cessation prompted by health problems.

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