Myocardial infarction: a nurse-led smoking cessation program was cost-effective.

Clinical bottom line (level 1b)

  1. A nurse-led smoking cessation program was a cost-effective way of helping smokers, following a myocardial infarction, to quit.
Krumholz et al: Journal of the American College of Cardiology 1993; 22 (6): 1697-1702
Expires March 2003

The study

cost-effectiveness analysis
Setting: university hospital, USA

Decision analysis constructed using data from a randomised controlled trial comparing nursing-managed smoking cessation program with usual care.

  • Viewpoint: National Health Service or HMO
  • Benefit assessment: smoking cessation at 1 year
  • Resources and costs: nurses' salaries and cost of manuals. The cost of setting up the program and training the nurses, or indirect costs were not included.
  • Sensitivity analysis: Costs and effectiveness of the program were varied.

    • The evidence

    intervention cost
    cost per year of life saved $220

    Effect of sensitivity analysis: The program remained cost-effective despite wide variations in costs and treatment success.

    Comments

    1. The nursing smoking cessation program involved giving the patient a manual explaining how to identify high risk smoking situations and some counseling, followed by weekly phone-calls for 3 weeks, then monthly phone-calls for 4 months.
    2. New cessation methods involving nicotine replacement and bupropion therapy show good rates of cessation; could these make such methods even more cost effective?

    Citation

    1. Krumholz HM, Cohen BJ, Tsevat J, et al: cost-effectiveness of a smoking cessation program after myocardial infarction. Journal of the American College of Cardiology 1993; 22 (6): 1697-1702
    Search Terms: reference from review article
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer: Timo Strandberg

    Clinical Question.
    Patient smokers who have had an MI
    Intervention or Exposure nurse-led smoking cessation program
    Outcome cost-effectiveness