Abstract
BackgroundSmartphones are increasingly available and some high quality apps are available for smoking cessation. However, the cost-effectiveness of promoting such apps has never been studied. We therefore aimed to estimate the health gain, inequality impacts and cost-utility from a five-year promotion campaign of a smoking cessation smartphone app compared to business-as-usual (no app use for quitting).MethodsA well-established Markov macro-simulation model utilising a multi-state life-table was adapted to the intervention (lifetime horizon, 3% discount rate). The setting was the New Zealand (NZ) population (N = 4.4 million). The intervention effect size was from a multi-country randomised trial: relative risk for quitting at 6 months = 2.23 (95%CI: 1.08 to 4.77), albeit subsequently adjusted to consider long-term relapse. Intervention costs were based on NZ mass media promotion data and the NZ cost of attracting a smoker to smoking cessation services (NZ$64 per person).ResultsThe five-year intervention was estimated to generate 6760 QALYs (95%UI: 5420 to 8420) over the remaining lifetime of the population. For Māori (Indigenous population) there was 2.8 times the per capita age-standardised QALY gain relative to non-Māori. The intervention was also estimated to be cost-saving to the health system (saving NZ$115 million [m], 95%UI: 72.5m to 171m; US$81.8m). The cost-saving aspect of the intervention was maintained in scenario and sensitivity analyses where the discount rate was doubled to 6%, the effect size halved, and the intervention run for just 1 year.ConclusionsThis study provides modelling-level evidence that mass-media promotion of a smartphone app for smoking cessation could generate health gain, reduce ethnic inequalities in health and save health system costs. Nevertheless, there are other tobacco control measures which generate considerably larger health gains and cost-savings such as raising tobacco taxes.
Highlights
Smartphones are increasingly available and some high quality apps are available for smoking cessation
A third randomised controlled trials (RCT) was conducted in the United States (US) and involved mindfulness training via a smartphone app with experience sampling vs a control of experience sampling only [9]
The overall cost-saving aspect of the intervention was maintained in all sensitivity and scenario analyses including where the effect size was halved (Additional file 1: Table S7), the discount rate varied, including up to 6% (Additional file 1: Tables S8 and S9), and the intervention run for just one year (Additional file 1: Table S10)
Summary
Smartphones are increasingly available and some high quality apps are available for smoking cessation. Many evidence-based tobacco control interventions exist and new ones are continuing to emerge One such novel approach is the use of mobile phone-based interventions for smoking cessation. A particular strength of this study was the comparison of a “state-of-the-art” decision-aid design versus support with passive information-only apps Another RCT was conducted in Canada with 19 to 29 year-olds, and used a printed self-help guide for the control group [8]. A third RCT was conducted in the US and involved mindfulness training via a smartphone app with experience sampling vs a control of experience sampling only [9] (this experience sampling involved a component of the app which queried smoking, craving, and mindfulness in real time) It reported no group difference in smoking abstinence at 6 months (9.8% vs 12.1% in the two groups respectively, p = 0.51).
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