Estimating costs for modelling return on investment from smoking cessation interventions

Introduction Aim and objective: Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model (EQUIPTMOD). Methods Focused search of administrative and published data on dult population (15+ years) in Hungary, Netherlands, Germany, Spain and England. For passive smoking related costs, child population (0-15 years) was also included. A standardized checklist was developed in order to ensure consistency in methods of data collection. Costs of treating smoking attributable diseases; productivity losses due to smoking attributable absenteeism; and costs of implementing smoking cessation interventions were measured. Results Annual costs (per case) of treating smoking attributable lung cancer were between €5,074 (Hungary) and €52,106 (Germany); coronary heart disease between €1,521 (Spain) and €3,955 (Netherlands); chronic obstructive pulmonary disease between €1,280 (England) and €4,199 (Spain); stroke between €1,829 (Hungary) and €14,880 (Netherlands). Costs (per recipient) of smoking cessation medications were estimated to be: for standard duration of varenicline between €225 (England) and €465 (Hungary); for bupropion between €25 (Hungary) and €220 (Germany). Costs (per recipient) of providing behavioral support were also wide-ranging: one-to-one behavioural support between €34 (Hungary) and €474 (Netherlands); and group-based behavioural support between €12 (Hungary) and €257 (Germany). The costs (per recipient) of delivering brief physician advice were: €24 (England); €9 (Germany); €4 (Hungary); €33 (Netherlands); €27 (Spain). Conclusions Costs of treating smoking-attributable diseases as well as the costs of implementing smoking cessation interventions vary substantially across the five study countries. Estimates for the costs of these diseases and interventions can contribute to return on investment estimates in support of national or regional policy decisions. Funding We have received funding from the European Community's Seventh Framework Programme (The EQUIPT Project; grant agreement 602270). The funders had no influence in the conduction of this study or the drafting of this manuscript

Similarities and differences between stakeholders' opinions on using Health Technology Assessment (HTA) information across five European countries: results from the EQUIPT survey

Background The European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) project aimed to study transferability of economic evidence by co-creating the Tobacco Return On Investment (ROI) Tool, previously developed in the United Kingdom (UK), for four sample countries (Germany, Hungary, Spain and the Netherlands). The EQUIPT tool provides policy-makers and stakeholders with customized information about the economic and wider returns on the investment in evidence-based tobacco control including smoking cessation interventions. A Stakeholder Interview Survey was developed to engage with the stakeholders in early phases of the development and country adaptation of the ROI Tool. The survey assessed their information needs, their awareness about underlying principles used in economic analyses, their opinion about the importance, effectiveness and costeffectiveness of tobacco control interventions, and their willingness to use a Health Technology Assessment (HTA) tool such as the ROI Tool. Methods A cross sectional study using a mixed method approach was conducted among participating stakeholders in the sample countries and the UK. The individual questionnaire contained open-ended questions as well as single choice and seven-point or three-point Likert-scale questions. The results corresponding to the priority and needs assessment and to the awareness of stakeholders about underlying principles used in economic analysis are analysed by country and stakeholder categories. Results Stakeholders considered it important that the decisions on the investments in tobacco control interventions should be supported by scientific evidence including prevalence of smoking, cost of smoking, quality of life, mortality due to smoking, effectiveness, costeffectiveness and budget impact of smoking cessation interventions. The proposed ROI Tool was required to provide this granularity of information. The majority of the stakeholders were aware of the general principles of economic analyses used in decision making contexts but they did not appear to have in-depth knowledge about specific technical details. Generally, stakeholders' answers showed larger variability by country than by stakeholder category. Conclusions Stakeholders across different European countries view the use of HTA evidence to be an important factor in their decision-making process. They considered themselves to be capable to interpret the results from a return on investment tool, and highly motivated to use it.The research leading to these results has received funding from the European Community’s Seventh Framework Programme under grant agreement No. 602270 (EQUIPT)