title: Development and Validation of a Grading System for the Quality of Cost-Effectiveness Studies A Smoking-Cessation Intervention for Hospital Patients Projected cost-effectiveness of smoking cessation interventions in patients hospitalized with myocardial infarction. Economic evaluation of a telephone- and face-to-face-delivered counseling intervention for smoking cessation in patients with coronary heart disease Cost-effectiveness of smoking cessation treatment initiated during psychiatric hospitalization: analysis from a randomized, controlled trial. Cost-effectiveness of a hospital-based smoking cessation intervention. Nicotine patch therapy for smoking cessation combined with physician advice and nurse follow-up. One-year outcome and percentage of nicotine replacement. Smoking cessation in patients: two further studies by the British Thoracic Society. Research Committee of the British Thoracic Society. Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease Smoking cessation for hospitalized smokers: an evaluation of the "Ottawa Model".
abstract: Purpose .To provide a practical quantitative tool for appraising the quality of  cost-effectiveness ( CE ) studies . Methods .A committee comprised of health economists selected a set of criteria for the instrument from an item pool . Data collected with a conjoint analysis survey on 120 international health economists were used to estimate weights for each criterion with a r and om effects regression model . To vali date the grading system , a survey was sent to 60 individuals with health economics expertise . Participants first rated the quality  of three CE studies  on a visual analogue scale , and then evaluated each study using the  grading system . Spearman rho and Wilcoxon tests were used to detect convergent validity and analysis of covariance ( ANCOVA ) for discriminant validity . Agreement between the global rating by experts and the grading system was also examined . Results .Sixteen criteria were selected . Their coefficient estimates ranged from 1.2 to 8.9 , with a sum of 93.5 on a 100-point scale . The only insignificant criterion was “ use of subgroup analyses . ” Both convergent validity and discriminant validity of the grading system were shown by the results of the Spearman rho ( correlation coefficient = 0.78 , P < 0.0001 ) , Wilcoxon test ( P = 0.53 ) , and ANCOVA ( F3,146 = 5.97 , P = 0.001 ) . The grading system had good agreement with global rating by experts . Conclusions . The instrument appears to be simple , internally consistent , and valid for measuring the perceived quality of CE studies . Applicability for use in clinical and re source allocation decision-making deserves further study Many patients attempt to stop smoking during hospitalization , but most relapse after discharge . This study developed and evaluated a brief smoking-cessation and relapse-prevention program for hospitalized smokers . All hospitalized smokers ( n=1,119 ) were identified by question naire at hospital admission and then received either usual care or usual care plus a hospital-based smoking- cessation intervention regardless of interest in stopping smoking . Intervention components included a 20-minute bedside counseling session , a 12-minute videotape , a variety of self-help material s , and a follow-up telephone call . Special attention was given to techniques for preventing relapse after hospital discharge . Defining ex-smokers as those who reported no tobacco use at both 3- and 12-month follow-up assessment s , and counting those lost to follow-up as smokers , the intervention increased the proportion of patients who quit smoking by one half ( 9.2%vs 13.5 % , P<0.05 ) . These results demonstrate the efficacy of a brief in-hospital intervention and suggest that relapse-prevention efforts are needed to convert temporary cessation during hospitalization into longterm abstinence BACKGROUND As many as 70 % of smokers with acute myocardial infa rct ion ( AMI ) continue to smoke after hospital discharge despite high rates of inpatient smoking cessation counseling . Supportive contact after discharge improves quit rates but is rarely used . METHODS Using data from a meta- analysis of r and omized trials of smoking cessation interventions and other published sources , we developed a Monte Carlo model to project health and economic outcomes for a hypothetical US cohort of 327,600 smokers hospitalized with AMI . We compared routine care , consisting of advice to quit smoking , with counseling with supportive follow-up , consisting of routine care and follow-up telephone calls from a nurse after discharge . Primary outcomes were number of smokers , AMIs , and deaths averted ; health care and productivity costs ; cost per quitter ; and cost per quality -adjusted life-year . RESULTS Implementation of smoking cessation counseling with follow-up contact for the 2010 cohort of hospitalized smokers would create 50,230 new quitters , cost $ 27.3 million in nurse wages and material s , and prevent 1380 nonfatal AMIs and 7860 deaths . During a 10-year period , it would save $ 22.1 million in reduced hospitalizations but increase health care costs by $ 166.4 million , primarily through increased longevity . Productivity costs from premature death would fall by $ 1.99 billion and nonmedical expenditures would increase by $ 928 million , for a net positive value to society of $ 894 million . The program would cost $ 540 per quitter considering only intervention costs . Cost-effectiveness would be $ 5050 per quality -adjusted life-year . Results were sensitive to the utility and incidence of nonfatal AMI and the potential effect of pharmacotherapies . CONCLUSION Smoking cessation counseling with supportive contact after discharge is potentially cost-effective and may reduce the incidence of smoking and its associated adverse health events and social costs Objective This study examined the cost-effectiveness and cost-utility of two smoking cessation counseling interventions differing in their modality for patients diagnosed with coronary heart disease from a societal perspective . Methods In a r and omized controlled trial conducted in Dutch hospital wards , cardiac patients who smoked prior to admission were allocated to  usual care ( n = 245 ) ,  telephone counseling ( n = 223 ) or face-to-face counseling ( n = 157 ) . The counseling interventions lasted for 3 months and were complemented by nicotine patches . Baseline histories were obtained , and interviews took place 6 months after hospitalization to assess self-reported smoking status and quality adjusted life years ( QALYs ) . Incremental cost-effectiveness ratios per quitter and cost-utility ratios per QALY were calculated and presented in acceptability curves . Uncertainty was accounted for by sensitivity analysis . Results Using continued abstinence as the outcome measure showed that telephone counseling had the highest probability of being cost-effective . Face-to-to-face counseling was also more cost-effective than usual care . No significant improvements and differences in QALYs between the three conditions were found . Varying costs and effect estimations revealed that the results of the primary analyses were robust . Conclusions Assuming a willingness-to-pay of € 20,000 per abstinent patient , telephone counseling would be a highly cost-effective smoking cessation intervention assisting cardiac patients to quit . However , the lack of consensus concerning the willingness-to-pay per quitter impedes drawing firm conclusions . Moreover , studies with extended follow-up periods are needed to capture late relapses and possible differences in QALYs OBJECTIVE We examined the cost-effectiveness of smoking cessation treatment for psychiatric in patients . METHOD Smokers , regardless of intention to quit , were recruited during psychiatric hospitalization and r and omized to receive stage-based smoking cessation services or usual aftercare .  Smoking cessation services , quality of life , and biochemically verified abstinence from cigarettes were assessed during 18 months of follow-up . A Markov model of cost-effectiveness over a lifetime horizon was constructed using trial findings and parameters obtained in a review of the literature on quit and relapse rates and the effect of smoking on health care cost , quality of life , and mortality . RESULTS Among 223 smokers r and omized between 2006 and 2008 , the mean cost of smoking cessation services was $ 189 in the experimental treatment group and $ 37 in the usual care condition ( P < .001 ) . At the end of follow-up , 18.75 % of the experimental group was abstinent from cigarettes , compared to 6.80 % abstinence in the usual care group ( P < .05 ) . The model projected that the intervention added $ 43 in lifetime cost and generated 0.101 additional quality -adjusted life-years ( QALYs ) , an incremental cost-effectiveness ratio of $ 428 per QALY . Probabilistic sensitivity analysis found the experimental intervention was cost-effective against the acceptance criteria of $ 50,000/QALY in 99.0 % of the replicates . CONCLUSIONS A cessation intervention for smokers identified in psychiatric hospitalization did not result in higher mental health care costs in the short-run and was highly cost-effective over the long-term . The stage-based intervention was a feasible and cost-effective way of addressing the high smoking prevalence in persons with serious mental illness . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00136812 OBJECTIVES This study evaluated the cost-effectiveness of a  smoking cessation and relapse-prevention program  for hospitalized adult smokers from the perspective of an implementing hospital . It is an economic analysis of a two-group , controlled clinical trial in two acute care hospitals owned by a large group-model health maintenance organization . The intervention included a 20-minute bedside counseling session with an experienced health counselor , a 12-minute video , self-help material s , and one or two follow-up calls . METHODS Outcome measures were incremental cost ( above usual care ) per quit attributable to the intervention and incremental cost per discounted life-year saved attributable to the intervention . RESULTS Cost of the research intervention was $ 159 per smoker , and incremental cost per incremental quit was $ 3,697 . Incremental cost per incremental discounted life-year saved ranged between $ 1,691 and $ 7,444 , much less than most other routine medical procedures . Replication scenarios suggest that , with realistic implementation assumptions , total intervention costs would decline significantly and incremental cost per incremental discounted life-year saved would be reduced by more than 90 % , to approximately $ 380 . CONCLUSIONS Providing brief smoking cessation advice to hospitalized smokers is relatively inexpensive , cost-effective , and should become a part of the st and ard of inpatient care OBJECTIVE To determine the efficacy of a 22-mg nicotine patch combined with the National Cancer Institute program for physician advice and nurse follow-up in providing withdrawal symptom relief , 1-year smoking cessation outcome , and percentage of nicotine replacement . DESIGN R and omized , double-blind , placebo-controlled trial . SUBJECTS Two-hundred forty healthy volunteers who were smoking at least 20 cigarettes per day . INTERVENTIONS Based on the National Cancer Institute program , subjects received smoking cessation advice from a physician . Follow-up and relapse prevention were provided by a study nurse during individual counseling sessions . Subjects were r and omly assigned to 8 weeks of a 22-mg nicotine or placebo patch . MAIN OUTCOME MEASURES Abstinence from smoking was verified by expired air carbon monoxide levels . Withdrawal symptoms were recorded during patch therapy , and the percentage of nicotine replacement was calculated by dividing serum nicotine and cotinine levels at week 8 of patch therapy by levels obtained while smoking . RESULTS Higher smoking cessation rates were observed in the active nicotine patch group at 8 weeks ( 46.7 % vs 20 % ) ( P < .001 ) and at 1 year ( 27.5 % vs 14.2 % ) ( P = .011 ) . Higher smoking cessation rates were also observed in subjects assigned to the active patch who had lower serum levels of nicotine and cotinine at baseline , and withdrawal symptom relief was better in the active patch group compared with placebo . CONCLUSIONS Clinical ly significant smoking cessation can be achieved using nicotine patch therapy combined with physician intervention , nurse counseling , follow-up , and relapse prevention . Smokers with lower baseline nicotine and cotinine levels had better cessation rates , which provides indirect evidence that they had more adequate nicotine replacement with this fixed dose of transdermal nicotine than those smokers with higher baseline levels The effects of various smoking cessation strategies were studied in two multicentre trials with new patients attending hospital or a chest clinic because of a smoking related disease . In the first trial ( study A , 1462 patients ) the effect of the physician 's usual advice to stop smoking was compared with the effect of the same advice reinforced by a signed agreement to stop smoking by a target date within the next week , two visits by a health visitor in the first six weeks , and a series of letters of encouragement from the physician . The second trial ( study B , 1392 patients ) compared ( 1 ) advice only , ( 2 ) advice supplemented by a signed agreement , ( 3 ) advice supplemented by a series of letters of encouragement , and ( 4 ) advice supplemented by a signed agreement and a series of letters of encouragement . Patients were review ed at six months and those cl aim ing to have stopped smoking were seen again at 12 months . Cl aims of abstinence were checked by carboxyhaemoglobin measurement . In study A 9 % of the intervention group had succeeded in stopping smoking at six months compared with 7 % of the " advice only " patients ( p = 0.17 ) . In study B success rates were 5.2 % , 4.9 % , 8.5 % , and 8.8 % respectively . The signed agreement did not influence outcome , whereas postal encouragement increased the effect of the physician 's advice . In both studies patients review ed clinical ly between the initial and the six month visit were more likely to stop smoking than those not review ed . Success rates increased with age and men tended to do better than women . The studies suggest that physician 's advice alone will persuade 5 % of out patients with a smoking related disease to stop smoking . Subsequent postal encouragement will increase the cessation rate by more than half as much again . Such small improvements in success rates are worth while , especially if they can be achieved cheaply and on a wide scale Background Smoking cessation is probably the most important action to reduce mortality after a coronary event . Smoking cessation programs are not widely implemented in patients with coronary heart disease , however , possibly because they are thought not to be worth their costs . Our objectives were to estimate the cost effectiveness of a smoking cessation program , and to compare it with other treatment modalities in cardiovascular medicine . Methods A cost-effectiveness analysis was performed on the basis of a recently conducted r and omized smoking cessation intervention trial in patients admitted for coronary heart disease . The cost per life year gained by the smoking cessation program was derived from the re sources necessary to implement the program , the number needed to treat to get one additional quitter from the program , and the years of life gained if quitting smoking . The cost effectiveness was estimated in a low-risk group ( i.e. patients with stable coronary heart disease ) and a high-risk group ( i.e. patients after myocardial infa rct ion or unstable angina ) , using survival data from previously published investigations , and with life-time extrapolation of the survival curves by survival function modeling . Results In a lifetime perspective , the incremental cost per year of life gained by the smoking cessation program was ∊280 and ∊110 in the low and high-risk group , respectively ( 2000 prices ) . These costs compare favorably to other treatment modalities in patients with coronary heart disease , being approximately 1/25 the cost of both statins in the low-risk group and angiotensin-converting enzyme inhibitors in the high-risk group . In a sensitivity analysis , the costs remained low in a wide range of assumptions . Conclusions A nurse-led smoking cessation program with several months of intervention is very cost-effective compared with other treatment modalities in patients with coronary heart disease abstract Objective To determine whether a nurse led smoking cessation intervention affects smoking cessation rates in patients admitted for coronary heart disease . Design R and omised controlled trial . Setting Cardiac ward of a general hospital , Norway . Participants 240 smokers aged under 76 years admitted for myocardial infa rct ion , unstable angina , or cardiac bypass surgery . 118 were r and omly assigned to the intervention and 122 to usual care  ( control group ) . Intervention The intervention was based on a booklet and focused on fear arousal and prevention of relapses .  The intervention was delivered by cardiac nurses without special training . The intervention was initiated in hospital , and the participants were contacted regularly for at least five months . Main outcome measure Smoking cessation rates at 12 months determined by self report and biochemical verification . Results 12 months after admission to hospital , 57 % ( n = 57/100)of patients in the intervention group and 37 % ( n = 44/118 ) in the control group had quit smoking ( absolute risk reduction 20 % , 95 % confidence interval 6 % to 33 % ) . The number needed to treat to get one additional person who would quit was 5 ( 3 to 16 ) . Assuming all dropouts relapsed at 12 months , the smoking cessation rates were 50 % in the intervention group and 37 % in the control group ( absolute risk reduction 13 % , 0 % to 26 % ) . Conclusion A smoking cessation programme delivered by cardiac nurses without special training , significantly reduced smoking rates in patients 12 months after admission to hospital for coronary heart disease INTRODUCTION Interventions for hospitalized smokers can increase long-term smoking cessation rates . The Ottawa Model for Smoking Cessation ( the " Ottawa Model " ) is an application of the " 5 A 's " approach to cessation , customized to the hospital setting . This study evaluated the impact of implementing the Ottawa Model in 9 hospitals in eastern Ontario . METHODS The RE- AIM ( Reach , Efficacy , Adoption , Implementation , and Maintenance ) framework was used to evaluate the intervention . Trained outreach facilitators assisted 9 hospitals to implement the Ottawa Model ; program delivery was then monitored over a 1-year period using administrative data and data from a follow-up data base . A before- and -after study was conducted to gauge the effect of the Ottawa Model program on cessation rates 6 months after hospitalization . Self-reports of smoking cessation were biochemically confirmed in a r and om sample of patients , and all cessation rates were corrected for potential misreporting . RESULTS Sixty-nine percent of the expected number of smokers received the Ottawa Model intervention . Controlling for hospital , the confirmed 6-month continuous abstinence rate was higher after , than before , introduction of the Ottawa Model ( 29.4 % vs. 18.3 % ; odds ratio = 1.71 , 95 % CI = 1.11 - 2.64 ; Z = 2.43 ; I(2 ) = 0 % ; p = .02 ) . The intervention was more likely to accomplish counseling for smokers than delivery of medications or postdischarge follow-up . Attitudinal , managerial , and environmental challenges to program implementation were identified . DISCUSSION Trained outreach facilitators successfully implemented the Ottawa Model in 9 hospitals leading to significantly higher long-term cessation rates . The public health implication s of systematic cessation programs for hospitalized smokers are profound
target: This study provides robust evidence supporting the cost-effectiveness of smoking cessation programs for hospitalized patients .
  In addition , the results indicated that the degree of cost-effectiveness of the inpatient smoking cessation program might not be related to either the components of the program or method ological variations in the cost-effectiveness analysis .
background: This systematic review examined the characteristics of published cost-effectiveness analyses of  inpatient smoking cessation programs  and assessed the method ological quality of the selected studies , to provide policymakers with economic evidence for this type of program .