From the Research
The most cost-effective approach to smoking cessation is a combination of behavioral counseling and first-line pharmacotherapy, specifically nicotine replacement therapy (NRT), as it offers excellent value and doubles or triples quit success rates compared to unassisted attempts. This approach typically costs $100-300 for a full treatment course 1. The effectiveness of this combination stems from addressing both the physical nicotine addiction through medication and the behavioral/psychological aspects through counseling.
Key Components of Cost-Effective Smoking Cessation
- Nicotine patches (21mg/24hr for those smoking >10 cigarettes/day, stepping down to 14mg and 7mg over 8-12 weeks) combined with a short-acting NRT form like nicotine gum (2-4mg as needed for cravings) offers excellent value.
- Counseling should include at least four sessions of 10+ minutes each, focusing on problem-solving skills and social support.
- For those with limited resources, even brief counseling with quitlines (available at 1-800-QUIT-NOW) combined with over-the-counter NRT provides substantial cost-effectiveness.
Comparison with Other Interventions
While other medications like varenicline (Chantix) and bupropion (Zyban) are effective, they generally cost more than NRT while offering similar success rates 2, 3. Telephone counseling also appears to be a highly cost-effective strategy, especially when combined with pharmacotherapies like bupropion 1.
Cost-Effectiveness Analysis
Studies have shown that smoking cessation programs are highly cost-effective, with costs per life-year saved ranging from $1,441 to $3,455 for NRT and $920 to $2,150 for bupropion SR 4. The cost-effectiveness of these interventions is stable against usual care in sensitivity analyses 2.
Implementation
To implement this cost-effective approach, set a quit date, begin the patch on that day, and use the gum when cravings occur (up to 24 pieces per day). General practitioners should be encouraged to refer patients to telephone quit lines and consider the addition of telephone counseling when prescribing pharmacotherapy 1.