Impact and cost-effectiveness of smoking interventions

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Abstract

Cigarette smoking is the foremost preventable cause of death in the United States. Along with being a major contributor to lung cancer, chronic obstructive pulmonary disease, and cerebrovascular disease, smoking is one of several modifiable risk factors for coronary artery disease (CAD).

The Coronary Heart Disease Policy Model is a computer simulation model of CAD in the United States. Using the model, one can project CAD incidence, prevalence, events, mortality, cost, cost-effectiveness, and gains in life expectancy from various risk factor modifications, including smoking interventions. The model projects that reducing the number of cigarettes smoked by 50% would increase the population-wide life expectancy of 35-year-old U.S. citizens by 0.4 year. Eliminating smoking would yield population-wide gains of 0.8 year for 35-year-old males and 0.7 year for 35-year-old females. These gains are comparable to those achieved with strict control of cholesterol levels, diastolic blood pressure, or weight.

Gains for the smokers themselves would be much greater. On average, 35-year-old male smokers would live 1.2 years longer if they reduced the number of cigarettes smoked by 50%, and 2.3 years longer if they quit smoking. Females 35 years of age would live 1.5 years longer by cutting back by 50% and 2.8 years longer by quitting. These gains are equal to or greater than gains that individuals would realize by reducing serum cholesterol levels of 240–299 mg/dL to 200 mg/dL; controlling mild hypertension; or reducing weight from ≥130% ideal body weight to ideal body weight. Gains projected by the Coronary Heart Disease Policy Model are comparable to those forecast by others, who have projected that young adults would gain approximately 0.2–8.7 years by quitting smoking, depending on their smoking history.

Two studies have examined the cost-effectiveness of smoking interventions. One found that counseling smokers to quit would cost only $705–988 per year of life saved for males and $1,204–2,058 per year of life saved for females. The second study found that prescribing nicotine gum as an adjunct to counseling would cost only $4,113–6,465 per year of life saved for males and $6,880–9,473 per year of life saved for females. These cost-effectiveness ratios are more favorable than those of most other current healthcare interventions.

Smoking cessation would increase population-wide life expectancy by about a year and the life expectancy of a smoker by several years. Simple interventions on the part of physicians to get smokers to quit are among the most cost-effective uses of healthcare resources.

References (35)

  • G Rose et al.

    Effects of coronary risk reduction on the pattern of mortality

    Lancet

    (1990)
  • U.S. Department of Health and Human Services

    The health benefits of smoking cessation: a report of the surgeon general

  • MC Weinstein et al.

    Forecasting coronary heart disease incidence, mortality, and cost: the Coronary Heart Disease Policy Model

    Am J Public Health

    (1987)
  • L Goldman et al.

    Relative impact of targeted versus population-wide cholesterol interventions on the incidence of coronary heart disease: projections of the Coronary Heart Disease Policy Model

    Circulation

    (1989)
  • JT Edelson et al.

    Long-term cost-effectiveness of various initial monotherapies for mild to moderate hypertension

    JAMA

    (1990)
  • ANA Tosteson et al.

    Long-term impact of smoking cessation on the incidence of coronary heart disease: projections of the Coronary Heart Disease Policy Model

    Am J Public Health

    (1990)
  • L Goldman et al.

    Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease

    JAMA

    (1991)
  • J Tsevat et al.

    Expected gains in life expectancy from various coronary heart disease risk factor modifications

    Circulation

    (1991)
  • National Center for Health Statistics. Unpublished data from the Second Health and Nutrition Examination Survey,...
  • National Center for Health Statistics. Unpublished data from the Health Interview Survey,...
  • U.S. Department of Health and Human Services

    The Framingham Study: an epidemiological investigation of cardiovascular disease

  • U.S. Department of Health, Education, and Welfare

    The Framingham Study: an epidemiological investigation of cardiovascular disease

  • S Pell et al.

    Trends in the incidence of myocardial infarction and in associated mortality and morbidity in a large employed population

    N Engl J Med

    (1985)
  • U.S. Bureau of the Census

    Estimates of the civilian population of the United States by age, sex, and race: 1980–1983

  • U.S. Bureau of the Census

    Preliminary estimates of the population of the United States by age, sex, and race, 1970–1981

  • U.S. Bureau of the Census

    Projections of the population of the United States by age, sex, and race: 1982–2050

  • National Center for Health Statistics
  • Cited by (0)

    This work was supported in part by grant 86-3192 from the Henry J. Kaiser Family Foundation and grant 1R01-HS-06258 from the Agency for Health Care Policy and Research.

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