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COST-UTILITY ANALYSIS OF SMOKING CESSATION TO PREVENT OPERATIVE COMPLICATIONS FOLLOWING ELECTIVE ABDOMINAL COLON SURGERY
Audrey S. Kulaylat*, Christopher S. Hollenbeak, David Soybel
Surgery, Penn State Hershey Medical Center, Hershey, PA
Background
In patients undergoing elective procedures, such as colon resections, smoking is a known risk factor for postoperative complications. While therapies for smoking cessation exist, they are not consistently effective, and it is unclear whether providing a particular therapy to all patients undergoing elective colectomy would be a cost-effective strategy. This study models a known driver of increased healthcare costs—tobacco smoking—using the available therapies for smoking cessation, in order to determine whether uniform adoption of a particular smoking cessation strategy represents a cost-effective decision in the preoperative optimization of patients requiring elective colectomy.
Methods
A decision tree model was constructed to represent a provider's decision to provide either bupropion, nicotine replacement therapy, varenicline, or no standardized therapy to all patients presenting for elective colectomy. Probabilities and utilities obtained from the literature were used to parameterize the model, and institutional one-year cost data was used to estimates costs associated with complicated and uncomplicated postoperative courses. Incremental cost per quality-adjusted life year (QALY) was the primary outcome.
Results
Results from the base case analysis suggest that bupropion is cost-effective with an incremental cost-effectiveness ratio of approximately $75,000 per QALY. One-way and two-way sensitivity analyses established ranges for which of the three medications were either cost-effective or dominant compared to the baseline strategy of no uniform therapy. At costs below $145 for a course of therapy, the bupropion strategy dominates no therapy, and at costs of varenicline below $285, varenicline dominates no therapy. If the cost of varenicline was reduced to below $143 for a course of therapy, then varenicline would be overall less costly and more effective than both the bupropion and no standardized therapy strategies.
Conclusions
These results provide objective estimates by which healthcare organizations can make decisions on whether the use of particular smoking cessation therapies represent good value for patients and providers.
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