Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling Cost-Effectiveness and Cost-Utility of Internet-Based Computer Tailoring for Smoking Cessation Cost-effectiveness of smoking cessation treatment initiated during psychiatric hospitalization: analysis from a randomized, controlled trial. Dissemination of an effective inpatient tobacco use cessation program. Economic evaluation of a telephone- and face-to-face-delivered counseling intervention for smoking cessation in patients with coronary heart disease Implementation and effectiveness of a brief smoking-cessation intervention for hospital patients. Cost-effectiveness of an intensive smoking cessation intervention for COPD outpatients. Cost-effectiveness of a hospital-based smoking cessation intervention. Determining the cost-effectiveness of a computer-based smoking cessation intervention in primary care. Effectiveness of smoking-cessation interventions for urban hospital patients: study protocol for a randomized controlled trial Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial Efficacy of an internet program for smoking cessation during and after inpatient rehabilitation treatment: a quasi-randomized controlled trial. Application of a nurse-managed inpatient smoking cessation program. The Effectiveness of a Nursing Inpatient Smoking Cessation Program in Individuals With Cardiovascular Disease Cost-effectiveness of a voucher-based intervention for smoking cessation Cost-effectiveness of extended cessation treatment for older smokers. Comparative effectiveness of post-discharge interventions for hospitalized smokers: study protocol for a randomized controlled trial
Background  Physician training in smoking cessation counseling  has been shown to be effective as a means to increase quit success . We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme . Its effectiveness was previously demonstrated in a cluster r and omized , control trial performed in two Swiss university out patients clinics , in which residents were r and omized to receive training in smoking interventions or a control educational intervention .  Design and methods We used a Markov simulation model for effectiveness analysis . This model incorporates the intervention efficacy , the natural quit rate , and the lifetime probability of relapse after 1-year abstinence . We used previously published results in addition to hospital service and outpatient clinic cost data . The time horizon was 1 year , and we opted for a third-party payer perspective . Results The incremental cost of the intervention amounted to US$ 2.58 per consultation by a smoker , translating into a cost per life-year saved of US$ 25.4 for men and 35.2 for women . One-way sensitivity analyses yielded a range of US$ 4.0 - 107.1 in men and US$ 9.7 - 148.6 in women . Variations in the quit rate of the control intervention , the length of training effectiveness , and the discount rate yielded moderately large effects on the outcome . Variations in the natural cessation rate , the lifetime probability of relapse , the cost of physician training , the counseling time , the cost per hour of physician time , and the cost of the booklets had little effect on the cost-effectiveness ratio . Conclusions Training residents in smoking cessation counseling  is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions Background Although effective smoking cessation interventions exist , information is limited about their cost-effectiveness and cost-utility . Objective To assess the cost-effectiveness and cost-utility of an Internet-based multiple computer-tailored smoking cessation program and tailored counseling by practice nurses working in Dutch general practice s compared with an Internet-based multiple computer-tailored program only and care as usual . Methods The economic evaluation was embedded in a r and omized controlled trial , for which 91 practice nurses recruited 414 eligible smokers . Smokers were r and omized to receive multiple tailoring and counseling ( n=163 ) , multiple tailoring only ( n=132 ) , or usual care ( n=119 ) . Self-reported cost and quality of life were assessed during a 12-month follow-up period . Prolonged abstinence and 24-hour and 7-day point prevalence abstinence were assessed at 12-month follow-up . The trial-based economic evaluation was conducted from a societal perspective . Uncertainty was accounted for by bootstrapping ( 1000 times ) and sensitivity analyses . Results No significant differences were found between the intervention arms with regard to baseline characteristics or effects on abstinence , quality of life , and addiction level . However , participants in the multiple tailoring and counseling group reported significantly more annual health care – related costs than participants in the usual care group . Cost-effectiveness analysis , using prolonged abstinence as the outcome measure , showed that the mere multiple computer-tailored program had the highest probability of being cost-effective . Compared with usual care , in this group € 5100 had to be paid for each additional abstinent participant . With regard to cost-utility analyses , using quality of life as the outcome measure , usual care was probably most efficient . Conclusions To our knowledge , this was the first study to determine the cost-effectiveness and cost-utility of an Internet-based smoking cessation program with and without counseling by a practice nurse . Although the Internet-based multiple computer-tailored program seemed to be the most cost-effective treatment , the cost-utility was probably highest for care as usual . However , to ease the interpretation of cost-effectiveness results , future research should aim at identifying an acceptable cutoff point for the willingness to pay per abstinent participant OBJECTIVE We examined the cost-effectiveness of smoking cessation treatment for psychiatric in patients . METHOD Smokers , regardless of intention to quit , were recruited during psychiatric hospitalization and r and omized to receive stage-based smoking cessation services or usual aftercare .  Smoking cessation services , quality of life , and biochemically verified abstinence from cigarettes were assessed during 18 months of follow-up . A Markov model of cost-effectiveness over a lifetime horizon was constructed using trial findings and parameters obtained in a review of the literature on quit and relapse rates and the effect of smoking on health care cost , quality of life , and mortality . RESULTS Among 223 smokers r and omized between 2006 and 2008 , the mean cost of smoking cessation services was $ 189 in the experimental treatment group and $ 37 in the usual care condition ( P < .001 ) . At the end of follow-up , 18.75 % of the experimental group was abstinent from cigarettes , compared to 6.80 % abstinence in the usual care group ( P < .05 ) . The model projected that the intervention added $ 43 in lifetime cost and generated 0.101 additional quality -adjusted life-years ( QALYs ) , an incremental cost-effectiveness ratio of $ 428 per QALY . Probabilistic sensitivity analysis found the experimental intervention was cost-effective against the acceptance criteria of $ 50,000/QALY in 99.0 % of the replicates . CONCLUSIONS A cessation intervention for smokers identified in psychiatric hospitalization did not result in higher mental health care costs in the short-run and was highly cost-effective over the long-term . The stage-based intervention was a feasible and cost-effective way of addressing the high smoking prevalence in persons with serious mental illness . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00136812 The present study aim ed to determine whether tobacco use cessation rates observed in controlled trials of a hospital-based tobacco use cessation program could be replicated when the program was disseminated to a wide range of hospitals in a two-stage process including implementation and institutionalization phases . Using a nonr and omized , observational design , we recruited six hospitals to participate in the study . The research team helped implement the program during the first year of participation ( implementation ) and then withdrew from active involvement during the second year ( institutionalization ) . The mean 6-month self-reported cessation rates were 26.3 % ( range = 17.6%-52.8 % ) for the implementation phase and 22.7 % ( range = 12.9%-48.2 % ) for the institutionalization phase . Hospitals with paid professionals providing the program had the best outcomes . Inpatient tobacco use cessation programs are feasible to implement and should target a 6-month self-reported cessation rate of at least 25 % Objective This study examined the cost-effectiveness and cost-utility of two smoking cessation counseling interventions differing in their modality for patients diagnosed with coronary heart disease from a societal perspective . Methods In a r and omized controlled trial conducted in Dutch hospital wards , cardiac patients who smoked prior to admission were allocated to  usual care ( n = 245 ) ,  telephone counseling ( n = 223 ) or face-to-face counseling ( n = 157 ) . The counseling interventions lasted for 3 months and were complemented by nicotine patches . Baseline histories were obtained , and interviews took place 6 months after hospitalization to assess self-reported smoking status and quality adjusted life years ( QALYs ) . Incremental cost-effectiveness ratios per quitter and cost-utility ratios per QALY were calculated and presented in acceptability curves . Uncertainty was accounted for by sensitivity analysis . Results Using continued abstinence as the outcome measure showed that telephone counseling had the highest probability of being cost-effective . Face-to-to-face counseling was also more cost-effective than usual care . No significant improvements and differences in QALYs between the three conditions were found . Varying costs and effect estimations revealed that the results of the primary analyses were robust . Conclusions Assuming a willingness-to-pay of € 20,000 per abstinent patient , telephone counseling would be a highly cost-effective smoking cessation intervention assisting cardiac patients to quit . However , the lack of consensus concerning the willingness-to-pay per quitter impedes drawing firm conclusions . Moreover , studies with extended follow-up periods are needed to capture late relapses and possible differences in QALYs OBJECTIVES Previous research has documented that hospital-based smoking-cessation counseling is efficacious and cost-effective when delivered by research staff . This study evaluated the implementation and effectiveness of this intervention program when delivered by respiratory therapists chosen from the regular hospital staff . METHODS A total of 1,173 hospitalized smokers were r and omly assigned to either usual care or a stage-based bedside counseling program supplemented with a videotape , self-help material s , and a follow-up telephone call . RESULTS Using an intent-to-treat analysis and counting those lost to follow-up as smokers , we did not find a significant difference in outcome between intervention ( 14.2 % reported being abstinent for > or = 6 months at the 1-year follow-up ) and usual care conditions ( 13.6 % abstinence ) . Process analyses revealed that these results were due to a combination of failure to reach many patients and reduced effectiveness of respiratory therapist interventionists compared with experienced professional counselors in a previous study conducted in the same hospitals . CONCLUSIONS We recommend implementation of hospital-based smoking-cessation counseling by professional counselors whose primary responsibility is to deliver the intervention . Recommendations for future research and for innovative ways to reach hospitalized smokers who are not receiving intervention are discussed INTRODUCTION To determine the cost-effectiveness of a high-intensity smoking cessation program ( SmokeStop Therapy ; SST ) versus a medium-intensity treatment ( Minimal Intervention Strategy for Lung patients [ LMIS ] ) for chronic obstructive pulmonary disease out patients . METHODS The cost-effectiveness analysis was based on a r and omized controlled trial investigating the effectiveness of the  SST  compared with the LMIS with 12-month follow-up . The primary outcome measure was the cotinine-vali date d continuous abstinence rate based on intention to treat . A health care perspective was adopted , with outcomes assessed in terms of ( incremental ) additional quitters gained , exacerbations prevented , and hospital days prevented . Health care re source use , associated with smoking cessation , was collected at baseline and 12 months after the start of the interventions . Monte Carlo simulations were performed to evaluate the robustness of the results . RESULTS The average patient receiving SST generated € 581 in health care costs , including the costs of the smoking cessation program , versus € 595 in the LMIS . The SST is also associated with a lower average number of exacerbations ( 0.38 vs. 0.60 ) and hospital days ( 0.39 vs. 1 ) per patient and a higher number of quitters ( 20 vs. 9 ) at lower total costs . This leads to a dominance of the SST compared with the LMIS . CONCLUSIONS The high-intensive SST is more cost-effective than the medium-intensive LMIS after 1 year . This is associated with cost savings per additional quitter , prevented exacerbations , and hospital days at lower or equal costs OBJECTIVES This study evaluated the cost-effectiveness of a  smoking cessation and relapse-prevention program  for hospitalized adult smokers from the perspective of an implementing hospital . It is an economic analysis of a two-group , controlled clinical trial in two acute care hospitals owned by a large group-model health maintenance organization . The intervention included a 20-minute bedside counseling session with an experienced health counselor , a 12-minute video , self-help material s , and one or two follow-up calls . METHODS Outcome measures were incremental cost ( above usual care ) per quit attributable to the intervention and incremental cost per discounted life-year saved attributable to the intervention . RESULTS Cost of the research intervention was $ 159 per smoker , and incremental cost per incremental quit was $ 3,697 . Incremental cost per incremental discounted life-year saved ranged between $ 1,691 and $ 7,444 , much less than most other routine medical procedures . Replication scenarios suggest that , with realistic implementation assumptions , total intervention costs would decline significantly and incremental cost per incremental discounted life-year saved would be reduced by more than 90 % , to approximately $ 380 . CONCLUSIONS Providing brief smoking cessation advice to hospitalized smokers is relatively inexpensive , cost-effective , and should become a part of the st and ard of inpatient care PURPOSE To evaluate the incremental effectiveness and cost-effectiveness of a staged-based , computerized smoking cessation intervention relative to st and ard care in an urban managed care network of primary care physicians . DESIGN Decision-analytic model based on results of a r and omized clinical trial . METHODOLOGY Patient outcomes and cost estimates were derived from clinical trial data . Effectiveness was measured in terms of 7-day point-prevalence abstinence at 6 months post-intervention . Quality -adjusted life years ( QALYs ) and cost-effectiveness ( CE ) were calculated , with CE measured as cost per patient per life year saved and per quality -adjusted life years saved . CE estimates were adjusted to account for partial behavior change as measured in terms of progression in stage of readiness to quit . Sensitivity analyses were conducted to evaluate the robustness of key model assumptions . PRINCIPAL FINDINGS Intervention patients were 1.77 times more likely to be smoke-free at 6 months follow-up than those in st and ard care ( p=.078 ) . The intervention generated an additional 3.24 quitters per year . Annualized incremental costs were $ 5,570 per primary care practice , and $ 40.83 per smoker . The mean incremental cost-effectiveness ratio was $ 1,174 per life year saved ( $ 869 per QALY ) . When the intervention impact on progression in stage of readiness to quit was also considered , the mean incremental cost-effectiveness ratio declined to $ 999 per life year saved ( $ 739 per QALY ) . CONCLUSIONS From a physician 's practice perspective , the stage-based computer tailored intervention was cost-effective relative to st and ard care . Incorporation of partial behavior change into the model further enhanced favorability of the cost-effectiveness ratio Background Hospitalization may be a particularly important time to promote smoking cessation , especially in the immediate post-discharge period . However , there are few studies to date that shed light on the most effective or cost-effective methods to provide post-discharge cessation treatment , especially among low-income population s and those with a heavy burden of mental illness and substance use disorders . Methods / design This r and omized trial will compare the effectiveness and cost-effectiveness of two approaches to smoking cessation treatment among patients discharged from two urban public hospitals in New York City . During hospitalization , staff will be prompted to ask about smoking and to offer nicotine replacement therapy ( NRT ) on admission and at discharge . Subjects will be r and omized on discharge to one of two arms : one arm will be proactive multi-session telephone counseling with motivational enhancement delivered by study staff , and the other will be a faxed or online referral to the New York State Quitline . The primary outcome is 30-day point-prevalence abstinence from smoking at 6-month follow-up post-discharge . We will also examine cost-effectiveness from a societal and a payer perspective , as well as explore subgroup analyses related to patient location of hospitalization , race/ethnicity , immigrant status , and inpatient diagnosis . Discussion This study will explore issues of implementation feasibility in a post-hospitalization patient population , as well as add information about the effectiveness and cost-effectiveness of different strategies for design ing smoking cessation programs for hospitalized patients .Trial registration Clinical trials.gov ID # Background The objectives of this smoking cessation study among hospitalized smokers are to : 1 ) determine provider and patient receptivity , barriers , and facilitators to implementing the nurse-administered , inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys ; 2 ) compare the effectiveness of the nurse-administered , inpatient Tobacco Tactics intervention versus usual care across hospitals , units , and patient characteristics using thirty-day point prevalence abstinence at thirty days and six months ( primary outcome ) post-recruitment ; and 3 ) determine the cost-effectiveness of the nurse-administered , inpatient Tobacco Tactics intervention relative to usual care including cost per quitter , cost per life-year saved , and cost per quality -adjusted life-year saved . Methods / Design This effectiveness study will be a quasi-experimental design of six Michigan community hospitals of which three will get the nurse-administered Tobacco Tactics intervention and three will provide their usual care . In both the intervention and usual care sites , research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at thirty days and six months post-recruitment . The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site . The Master Trainers , in turn , will teach the intervention to all staff nurses . Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination . Descriptive statistics will be used to summarize the results of surveys administered to nurses , nurses ’ participation rates , smokers ’ receipt of specific cessation services , and satisfaction with services . General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates , respectively , with adjustment for the clustering of patients within hospital units . Regression analyses will test the moderation of the effects of the interventions by patient characteristics . Cost-effectiveness will be assessed by constructing three ratios including cost per quitter , cost per life-year saved , and cost per quality -adjusted life-year saved . Discussion Given that nurses represent the largest group of front-line providers , this intervention , if proven effective , has the potential for having a wide reach and thus decrease smoking , morbidity and mortality among inpatient smokers . Trial registration Dissemination of Tobacco Tactics for Hospitalized Smokers OBJECTIVE To test the feasibility and efficacy of an internet program for smoking cessation during and after inpatient treatment in rehabilitation centers . METHODS A total of 7574 consecutively admitted in patients from three German rehabilitation centers were assessed for  smoking status . Daily smokers or former daily smokers who regularly used the internet and e-mail  were proactively invited for study participation . Out of 749 eligible patients , 477 ( 64 % ) participated in the study and were r and omly assigned to an intervention or an assessment only control group based on the calendar week of admission . Patients of the intervention group had the possibility to use an internet program for smoking cessation  for a period of six months . The program provided at least one but up to seven individual counseling sessions through a computer expert system , informational websites and a message board . RESULTS At six-months follow-up , seven-day point prevalence smoking abstinence was twice as high in the intervention group as in the control group ( OR=2.0 ; CI 1.1 - 3.8 ; p=.02 ) . CONCLUSIONS Proactive recruitment of smokers in combination with the provision of an internet program for smoking cessation allow for an inexpensive and effective smoking cessation support during and after inpatient rehabilitation treatment This study reports on the effectiveness of a nurse case-managed smoking cessation program for general hospitalized patients that was continued for 3 years after clinical trials were completed . Patients admitted to the hospital who smoked were offered a smoking cessation program during their hospitalization . The program included physician advice , bedside education and counseling with a nurse specially trained in smoking cessation techniques , take-home material s ( videotape , workbook , and relaxation audiotape ) , nicotine replacement therapy if requested or indicated , and four nurse-initiated post-discharge telephone counseling calls . Of the 2091 patients identified as smokers , 52 % enrolled in the program , 18 % wanted to quit on their own , 20 % did not want to quit , and 10 % were ineligible . The 12-month self-reported cessation rate ( 7-day point prevalence ) was 35 % if patients lost to follow-up were considered smokers , 49 % if not . Patients hospitalized for cancer , cardiovascular , or pulmonary reasons were most likely to participate and had the highest self-reported cessation rates ( 63 % , 57 % , and 46 % , respectively ) . This nurse-managed smoking cessation intervention  was effective when it was put into st and ard hospital practice outside of its originating r and omized clinical trial structure . The program , relatively inexpensive to deliver , appears to be acceptable to the majority of smokers who are hospitalized , result ed in high 1-year cessation rates , and can be extended to hospital employees and their families , work-sites , and communities on a cost-recovery basis Background Smoking is an important risk factor for cardiovascular disease ( CVD ) , and quitting is highly beneficial . Yet , less than 30 % of CVD patients stop smoking . Relapse-prevention strategies seem most effective when initiated during the exacerbation of the disease . Objective A nurse-delivered inpatient smoking cessation program based on the Transtheoretical Model with telephone follow-up tailored to levels of readiness to quit smoking was evaluated on smoking abstinence and progress to ulterior stages of change . Method Participants ( N = 168 ) were r and omly assigned by cohorts to inpatient counseling with telephone follow-up , inpatient counseling , and usual care . The inpatient intervention consisted of a 1-hr counseling session , and the telephone follow-up included 6 calls during the first 2 months after discharge . The nursing intervention was tailored to the individual 's stage of change . End points at 2 and 6 months included actual and continuous smoking cessation rates ( biochemical markers ) and increased motivation ( progress to ulterior stages of change ) . Results Assuming that surviving patients lost to follow-up were smokers , the 6-month smoking abstinence rate was 41.5 % in the inpatient counseling with telephone follow-up group , compared with 30.2 % and 20 % in the inpatient counseling and usual care groups , respectively ( p = .05 ) . Progress to ulterior stages of change was 43.3 % , 32.1 % , and 18.2 % , respectively ( p = .02 ) . Stage of change at baseline and intervention predicted smoking status at 6 months . Discussion This tailored smoking cessation program with telephone follow-up significantly increased smoking cessation at 6 months , and progression to ulterior stages of change . The telephone follow-up was an important adjunct . It is , therefore , recommended to include such comprehensive smoking cessation programs within hospital setting s for individuals with CVD ABSTRACT Background : Contingency management ( CM ) has been shown to be effective in reducing smoking consumption , but has traditionally been criticized for its costs . Objectives : This study assessed the cost-effectiveness of using a voucher-based CM protocol added to a cognitive behavioral treatment ( CBT ) for smoking cessation among treatment-seeking patients from the general population . Methods : A total of 92 patients were r and omly assigned to CBT or CBT plus CM for abstinence . Incremental cost-effectiveness ratios ( ICERs ) were calculated by dividing the increase in costs by the increase in effects ( continuous abstinence , longest duration of abstinence at 6-month follow-up and cotinine results during the treatment ) . An acceptability curve illustrated the statistical uncertainty surrounding the cost-effectiveness estimate . We also determined the optimum cost per participant for predicting the smoking status at 6-month follow-up . Results : The average cost per participant in the CBT condition was € 138.73 ( US$ 150.23 ) as opposed to € 411.61 ( US$ 445.73 ) in the CBT plus CM condition ( p < 0.01 ) . The incremental cost of using voucher-based CM to increase the number of participants that maintained abstinence at 6-month follow-up by one extra participant was € 68.22 ( US$ 73.88 ) , and to lengthen the longest duration of abstinence by 1 week was € 53.92 ( US$ 58.39 ) . The incremental cost to obtain an extra cotinine-negative result was € 181.90 ( US$ 196.98 ) . Conclusion : Compared with CBT alone , the voucher-based protocol required additional costs but achieved significantly better outcomes . These results will allow stakeholders to make policy decisions about CM implementation for smoking cessation in the broader community AIMS We examined the cost-effectiveness of extended smoking cessation treatment in older smokers . DESIGN Participants who completed a 12-week smoking cessation program were factorial r and omized to extended cognitive behavioral treatment and extended nicotine replacement therapy . SETTING A free-st and ing smoking cessation clinic . PARTICIPANTS A total of 402 smokers aged 50 years and older were recruited from the community . MEASUREMENTS The trial measured biochemically verified abstinence from cigarettes after 2 years and the quantity of smoking cessation services utilized . Trial findings were combined with literature on changes in smoking status and the age- and gender-adjusted effect of smoking on health-care cost , mortality and quality of life over the long term in a Markov model of cost-effectiveness over a lifetime horizon . FINDINGS The addition of extended cognitive behavioral therapy added $ 83 in smoking cessation services cost [ P = 0.012 , confidence interval ( CI ) = $ 22 - 212 ] . At the end of follow-up , cigarette abstinence rates were 50.0 % with extended cognitive behavioral therapy and 37.2 % without this therapy ( P < 0.05 , odds ratio 1.69 , CI 1.18 - 2.54 ) . The model-based incremental cost-effectiveness ratio was $ 6324 per quality -adjusted life year ( QALY ) . Probabilistic sensitivity analysis found that the additional $ 947 in lifetime cost of the intervention had a 95 % confidence interval of -$331 to 2081 ; the 0.15 additional QALYs had a confidence interval of 0.035 - 0.280 , and that the intervention was cost-effective against a $ 50 000/QALY acceptance criterion in 99.6 % of the replicates . Extended nicotine replacement therapy was not cost-effective . CONCLUSIONS Adding extended cognitive behavior therapy to st and ard cessation treatment was cost-effective . Further intensification of treatment may be warranted Background A hospital admission offers smokers an opportunity to quit . Smoking cessation counseling provided in the hospital is effective , but only if it continues for more than one month after discharge . Providing smoking cessation medication at discharge may add benefit to counseling . A major barrier to translating this research into clinical practice is sustaining treatment during the transition to outpatient care . An evidence -based , practical , cost-effective model that facilitates the continuation of tobacco treatment after discharge is needed . This paper describes the design of a comparative effectiveness trial testing a hospital-initiated intervention against st and ard care . Methods / design A two-arm r and omized controlled trial compares the effectiveness of st and ard post-discharge care with a multi-component smoking cessation intervention provided for three months after discharge . Current smokers admitted to Massachusetts General Hospital who receive bedside smoking cessation counseling , intend to quit after discharge and are willing to consider smoking cessation medication are eligible . Study participants are recruited following the hospital counseling visit  and r and omly assigned to receive St and ard Care or Extended Care  after hospital discharge . St and ard Care includes a recommendation for a smoking cessation medication and information about community re sources . Extended Care includes up to three months of free FDA -approved smoking cessation medication and five proactive computerized telephone calls that use interactive voice response technology to provide tailored motivational messages , offer additional live telephone counseling calls from a smoking cessation counselor , and facilitate medication refills . Outcomes are assessed at one , three , and six months after hospital discharge . The primary outcomes are self-reported and vali date d seven-day point prevalence tobacco abstinence at six months . Other outcomes include short-term and sustained smoking cessation , post-discharge utilization of smoking cessation treatment , hospital readmissions and emergency room visits , and program cost per quit . Discussion This study tests a disseminable smoking intervention model for hospitalized smokers . If effective and widely adopted , it could help to reduce population smoking rates and thereby reduce tobacco-related mortality , morbidity , and health care costs . Trial registration United States Clinical Trials Registry NCT01177176
This study provides robust evidence supporting the cost-effectiveness of smoking cessation programs for hospitalized patients .
In addition , the results indicated that the degree of cost-effectiveness of the inpatient smoking cessation program might not be related to either the components of the program or method ological variations in the cost-effectiveness analysis .
This systematic review examined the characteristics of published cost-effectiveness analyses of  inpatient smoking cessation programs  and assessed the method ological quality of the selected studies , to provide policymakers with economic evidence for this type of program .