Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

Aims To evaluate costs, effects and cost-effectiveness of increased reach of specific smoking cessation interventions in Germany. Design A Markov-based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health-care perspective (extended to include out-of-pocket payments) with life-time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates. Setting Germany. Participants Cohort of current smoking population (18+ years) in Germany. Interventions Interventions included group-based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group-based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57915 quit attempts), while prospective scenario2represented a higher reach, mirroringthe levels observed inEngland. Measurements EQUIPTMOD considered reach, interventioncost, number of quitters, quality-of-lifeyears (QALYs) gained, cost-effectivenessand returnon investment. Findings The highest returns throughreduction insmoking-related health-care costswere seen for the financial incentive programme ((sic)2.71 per (sic)1 invested), followed by that of group-based behavioural support ((sic)1.63 per (sic)1 invested), compared with no interventions. Varenicline had lower returns ((sic)1.02 per (sic)1 invested) than the other two interventions. At thepopulationlevel, prospective scenario1led to15 034QALYsgained and (sic)27millioncost-savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return-oninvestment estimates. At a hypothetical willingness-to-pay threshold of only (sic)5000, the probability of being cost-effective is approximately 75% for prospective scenario 1. Conclusions Increasing the reach of group-based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost-effective.