Article Figures & Data
Figures
- Figure 1
Lifetime effects of tobacco counseling vs no counseling in a US birth cohort of 4,000,000.
Note: Net costs include counseling, medication, and smoking-attributable medical costs. Stratified model inputs by age-group, including relative risks and costs, produce discontinuity in results reported by single year of age.
- Figure 2
Sensitivity analyses of youth and adult tobacco use counseling.
CBP = clinically preventable burden; CE = cost-effectiveness; QALY = quality-adjusted life year; SA = smoking-attributable.
a When net costs are negative, cost-effectiveness is expressed as net cost per person. When net costs are positive, cost-effectiveness is expressed as net cost per QALY.
b Net costs are expressed as per person; therefore, changes in utility values do impact the estimate of cost-savings.
c Disease risks and smoking costs are determined by smoking status independently from each other in the model. Changes to the risk of illness therefore do not impact cost-effectiveness.
d Complex interactions between changing baseline cessation probabilities and intervention effect on cessation probabilities affect smoking-attributable costs and expenditures on cessation medications in both the baseline and intervention scenarios. As result, the impact of changing baseline cessation probabilities on cost-effectiveness is nonlinear.
Tables
- Table 1
Health Impact and Cost-Effectiveness of Brief Tobacco Counseling in a US Birth Cohort of 4,000,000: Clinical Preventive Service Priorities Estimates
Effect Youth Counseling vs No Youth Counseling Adult Counseling vs No Adult Counseling Change in years lived as smokers, No. −4,971,393 −8,458,331 Change in adult smoking prevalence (weighted by cohort size at each age), % −2.0 −3.8 Change in years lived as former smokers, No. −8,140,126 9,502,722 Change in smoking-attributable cancers, No. −9,925 −14,679 Change in smoking-attributable CVD hospitalizations, No. −99,138 −176,045 Change in smoking-attributable respiratory disease hospitalizations, No. −126,270 −179,701 Change in smoking-attributable fatalities, No. −42,686 −69,901 Clinical preventable burden: change in QALYs saved, undiscounted, No. 756,601 1,044,392 Change in counseling and cessation medication costs, discounted, $ millions 914 427 Change in smoking-attributable medical costs, discounted, $ millions −1,814 −2,746 Change in total costs, discounted, $ millions −900 −2,319 Cost-effectiveness: discounted net costs per person, $/person −225 −580 CVD = cardiovascular disease; QALYs = quality-adjusted life years.
- Table 2
Health Impact and Cost-Effectiveness of Brief Tobacco Counseling in a US Birth Cohort of 4,000,000: Supplemental Analyses
Effect Youth and Adult Counseling vs No Counseling Adult Counseling vs Current Delivery Rates Youth and Adult Counseling vs Current Delivery Rates Change in years lived as smokers, No. −12,575,864 −4,391,547 −8,509,081 Change in adult smoking prevalence (weighted by cohort size at each age), % −5.5 −2.0 −3.6 Change in years lived as former smokers, No. 408,378 4,903,772 −214,198 Change in smoking-attributable cancers, No. −23,279 −7,142 −15,741 Change in smoking-attributable CVD hospitalizations, No. −259,128 −81,087 −164,171 Change in smoking-attributable respiratory disease hospitalizations, No. −290,432 −82,475 −193,206 Change in smoking-attributable fatalities, No. −105,917 −33,189 −69,205 Change in QALYs saved, undiscounted, No. 1,637,648 512,225 1,105,481 Change in counseling and cessation medication costs, discounted, $ millions 1,324 91 988 Change in smoking-attributable medical costs, discounted, $ millions −4,278 −1,444 −2,977 Change in total costs, discounted, $ millions −2,955 −1,353 −1,989 Cost-effectiveness: discounted net costs per person, $/person −739 −338 −497 CVD = cardiovascular disease; QALYs = quality-adjusted life years.
Supplemental Appendix
Supplemental Appendix
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults
Michael V. Maciosek , and colleagues
Background In the US, 42 million adults continue to smoke, and in 2015, 1.6 million middle- and high-school students self-reported smoking tobacco in the last 30 days. Smoking is still the leading cause of preventable death in the United States, with direct medical costs of about $175 billion per year. This study assesses the long-term value of providing brief, annual tobacco counseling to both youth and adults.
What This Study Found Brief tobacco counseling provides substantial health benefits while producing cost savings and is therefore a high-priority use of limited clinician time. Annual counseling for youth would reduce the average prevalence of smoking cigarettes during adult years by two percentage points. Annual counseling for adults would reduce prevalence by 3.8 percentage points. Youth counseling would prevent 42,686 smoking-attributable fatalities. Adult counseling would prevent 69,901 smoking-attributable fatalities. Youth and adult counseling would yield net savings of $225 and $580 per person, respectively. If annual tobacco counseling was provided during both youth and adult years, then adult smoking prevalence would be 5.5 percentage points lower compared with no counseling, and there would be 105,917 fewer smoking-attributable fatalities over their lifetimes. At current rates, only one-third of the potential health and economic benefits of counseling are being realized.
Implications
- Tobacco counseling can produce more meaningful improvements in population health with good stewardship of health care system resources than almost any other preventive service.
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