Cost-effectiveness of a specialist smoking cessation package compared with standard smoking cessation services for people with severe mental illness in England: a trial-based economic evaluation from the SCIMITAR+ study.

Jinshuo Li,Della Bailey,Scimitar+ Collaborative ,Steve Parrott,Emily Peckham,Paul Heron,Catherine Arundel,Catherine Hewitt,Caroline Fairhurst,Suzanne Crosland,Simon Gilbody

doi:10.1111/add.15086

Abstract

To evaluate the cost-effectiveness of a specialist smoking cessation package for people with severe mental illness DESIGN: Incremental cost-effectiveness analysis was undertaken from the UK National Health Service and Personal Social Services perspective over a 12-month time horizon. Total costs, including smoking cessation, health-care and social services costs and quality-adjusted life years (QALYs), derived from the five-level EuroQol 5-dimension (EQ-5D-5L), collected from a randomized controlled trial, were used as outcome measures. The bootstrap technique was employed to assess the uncertainty. Sixteen primary care and 21 secondary care mental health sites in England. Adult smokers with bipolar affective disorder, schizoaffective disorder or schizophrenia and related illnesses (n=526). A bespoke smoking cessation (BSC) package for people with severe mental illness offered up to 12 individual sessions with a mental health smoking cessation practitioner versus usual care (UC). Of the participants who were randomized, 261 were in UC group and 265 were in BSC group. BSC intervention cost was estimated from the treatment log. Costs of UC, health-care and social services and EQ-5D-5L were collected at baseline, 6- and 12-month follow-ups. Incremental costs and incremental QLAYs were estimated using regression adjusting for respective baseline values and other baseline covariates. The mean total cost in the BSC group was £270 [95% confidence interval (CI)=-£1690 to £1424] lower than in the UC group, while the mean QALYs were 0.013 (95% CI=-0.008 to 0.045) higher, leading to BSC dominating UC (76% probability of cost-effective at £20 000/QALY). A bespoke smoking cessation package for people with severe mental illness is likely to be cost-effective over 12months compared with usual care provided by the UK's National Health Service and personal social services.

Highlights

In 2018/19, Public Health England reported adult smoking prevalence in the general population as 14.5%, while in adults with long-term mental health conditions it was 26.8% [1]
The intervention was in line with the National Institute for Health and Care Excellence (NICE) guidelines [11] at the time of the trial and was delivered according to the Manual of Smoking Cessation developed by the National Centre for Smoking Cessation Training (NCSCT) [12] in the United Kingdom (UK), with adaptations to cater for people with severe mental illness (SMI) [13]
The results suggested that bespoke smoking cessation (BSC) was costlier than usual care (UC) and more effective, but incremental cost-effectiveness ratio (ICER) indicates that BSC is not cost-effective compared with UC under current maximum acceptable ICERs at point estimate, with a very high level of uncertainty (Table 2, right; Fig. 1, lower)

Summary

Introduction

In 2018/19, Public Health England reported adult smoking prevalence in the general population as 14.5%, while in adults with long-term mental health conditions it was 26.8% [1]. Smoking is the most important modifiable risk factor in health, this contributes to the widening health inequality suffered by people with SMI [4]. Facing this challenge, the importance of smoking cessation in people with SMI has been stressed and relevant goals have been set out, but little guidance is provided on how to tailor smoking cessation services in the United Kingdom (UK) to cater for the needs of this population [5,6]. Trial-based evidence suggests that behavioural support and pharmacotherapies can be as effective in helping people with SMI to quit as the general population [7]

Methods

Results

Conclusion