Abstract
Objective: To evaluate the impact of age at start of smoking cessation treatment (SCT) on predicted health benefits and costs over smokers' lifetimes.
Methods: A discrete event simulation of SCT allowing multiple quit attempts and estimates of lifetime health and economic outcomes was developed in a U.S. population. SCT types were assigned based on observed use.
Results: The predicted life expectancy of the 18 to 74 years old (mean age 42.1 years) reference population was 26.8 years, corresponding to 13.9 discounted quality adjusted life years (QALY). The lifetime cost of SCT averaged $1,462, with a total direct cost (tDC) of smoking-attributable disease of $54,550/smoker. Smokers averaged 7.9 QAs; 66.2% were permanent abstainers at the time of death. Smokers who started SCT at 35 to 40 years of age, accrued 15.6 discounted QALYs, and 71% achieved permanent abstinence. Smokers who start SCT between 45 and 50 years of age accrued 11.5 discounted QALYs and 60.2% achieved permanent abstinence at the time of death. Total abstinence times (tAT) were 10.1 vs. 7.2 years in the younger and older age groups, respectively, with corresponding SCT costs of $1,642 vs. $1,385 and lifetime tDC of disease of $43,306 vs. $72,439/smoker.
Conclusion: The number of individuals achieving permanent abstinence at the time of death is greater if smokers make their first quit attempt at age 35-40, rather than later at age 45-50. Despite longer survival times, their costs are lower. The lifetime cost of SCT is negligible compared with the tDC of smoking-attributable diseases. Based on simulations, the timing of SCT initiation is critical to optimize health benefits and to reduce costs of care.
- © 2011 ERS