Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD

Marta Trapero-Bertran*, Celia Munoz, Kathryn Coyle, Doug Coyle, Adam Lester-George, Reiner Leidl, Bertalan Nemeth, Kei-Long Cheung, Subhash Pokhrel, Angel Lopez-Nicolas

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). Design We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life-time costs and benefits. Setting Spain. Participants Adult smoking population (16+ years). Measurements Health-care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. Findings The cost of implementing the current provision of smoking cessation services is approximately (sic)61 million in the current year. This translates to 18 quitters per 1000 smokers and a life-time benefit-cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generatedmore QALYs) from the life-time perspective, comparedwith the current provision. The life-time benefit-cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. Conclusions According to the EQUIPTMODmodelling tool itwould be cost-effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro-active telephone support, and reimburse smoking cessationmedication to smokers trying to stop. Such policies wouldmore than pay for themselves in the long run.
Original languageEnglish
Pages (from-to)65-75
Number of pages11
Publication statusPublished - 1 Jun 2018


  • Cost-effectiveness
  • economic evaluation
  • smoking cessation interventions
  • tobacco control
  • Spain


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