Smoking Intervention is Cost-effective

When a health system reaches out to all their patients who smoke to talk about their tobacco journey, it spurs better health and saves money, according to a UW-CTRI paper in the American Journal of Preventive Medicine.

Dr. Marlon Mundt
Dr. Marlon Mundt, PhD

Dr. Marlon Mundt, lead author, a researcher from UW-CTRI and the UW Department of Family Medicine and Community Health, said the smoking intervention not only helped more people quit, but also reduced disease burden, while saving money on acute healthcare costs.

“I was very excited,” he said, “to observe a downward trend of decreasing acute-care costs for all patients in the clinics’ smoking registry” after the intervention. These acute care costs included urgent care visits, emergency room visits, and hospital stays. “The magnitude of cost-offsetting savings is getting stronger over time.”

The study findings are important because, while lawmakers and politicians may want to invest limited resources in programs that help people live healthier, some may balk if the investment doesn’t pay off financially right away.

Notably, the acute healthcare costs actually decreased—from $432 per patient per month before the intervention to just $390 per patient per month after. The health system saved $42 per patient per month for all patients in the clinics’ smoking registry after the intervention.

Monthly Acute Care Costs

Mundt said that’s encouraging because this was a real-world intervention at Group Health Cooperative of South Central Wisconsin (GHC-SCW). “The cost-effectiveness analysis included all costs associated with clinician and certified tobacco treatment specialist time, tobacco cessation medications and outreach mailings, including sample nicotine replacement therapy patches.”

How cost-effective? In simple terms, “health quality-adjusted life-years” gained is a measure to show how much it costs to improve health and longevity compared to other interventions.

“In health economics, if an additional quality-adjusted life-year is achieved for $50,000, it is considered a good health-promoting investment,” Mundt said. “In this study sample, the extra quality-adjusted life-year was gained for just a $905 financial investment. This is very inspiring and highly promising.”

The intervention also helped a higher number of patients to quit. Before the intervention, only 1.3% of GHC-SCW patients quit (approximately seven patients per month). That rate went up to 8.7% post-implementation (an average of 48 patients per month).

A total of 10,683 adults were in the GHC-SCW smoking registry during the study time frame of January 1, 2017 to February 29, 2020, Mundt said. Based on electronic health records (EHR), a total of 2,166 patients out of the 10,683 patients in the smoking registry (20.3% of patients) received tobacco cessation counseling and/or medication in the post-implementation period.

Tobacco treatment specialists worked for GHC so they could access the EHR and directly offer cessation counseling support by patient portal or phone. They also offered sample nicotine-replacement medications.

Results from the paper were also published on the news website, which gets 19,650 daily unique viewers. AMA Morning Rounds, the daily email news update from the American Medical Association, also shared the study and Healio article. AMA Morning Rounds goes to approximately 160,000 physicians, residents and students.

The study was made possible by a R35 grant to UW-CTRI Director Dr. Michael Fiore by the National Cancer Institute. The research was led by Fiore, UW-CTRI Associate Director Dr. Tim Baker and UW-CTRI Director of Research Dr. Danielle McCarthy, and managed by UW-CTRI Researcher Mark Zehner.

Mundt MP, McCarthy DE, Baker TB, Zehner ME, Zwaga D, Fiore MC. Cost-Effectiveness of a Comprehensive Primary Care Smoking Treatment Program. American Journal of Preventive Medicine. Online October 14, 2023.