The European Journal of Health Economics

, Volume 20, Issue 9, pp 1409–1424 | Cite as

Cost-effectiveness of smoking cessation programs for hospitalized patients: a systematic review

  • Donghoon Lee
  • Ye-Rin Lee
  • In-Hwan OhEmail author
Original Paper



This systematic review examined the characteristics of published cost-effectiveness analyses of inpatient smoking cessation programs and assessed the methodological quality of the selected studies, to provide policymakers with economic evidence for this type of program.


A literature search was undertaken using a relevant database by three investigators. Only full economic evaluations with results in the form of the incremental cost-effectiveness ratio (ICER) were included. Costs were adjusted to 2016 US dollars using the Gross Domestic Product deflator and purchasing power parities. The British Medical Journal checklist was utilized to appraise the methodological quality of the included studies.


Nine articles were ultimately selected. The inpatient smoking cessation programs appeared to be a highly cost-effective intervention according to the recommended cost-effectiveness thresholds by the World Health Organization or individual studies. The highest ICERs among the selected studies were $5593 per additional quit, $10,550 per life year gained, and $5680 per quality-adjusted life year gained.


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 methodological variations in the cost-effectiveness analysis. Policymakers should provide hospitals with resources and strong incentives to promote wider implementation of the smoking cessation program.


Smoking cessation Hospitalized patients Cost-effectiveness analysis Systematic review 

JEL Classification




We are grateful to two anonymous reviewers for helpful comments on an earlier version of this article. This research was partially supported by a grant from the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (Grant No. HI 13C0729).


  1. 1.
    National Center for Chronic Disease Prevention and Health Promotion (US), Office on Smoking and Health: The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Centers for Disease Control and Prevention, Atlanta (2014)Google Scholar
  2. 2.
    Gronkjaer, M., Eliasen, M., Skov-Ettrup, L.S., Tolstrup, J.S., Christiansen, A.H., Mikkelsen, S.S., Becker, U., Flensborg-Madsen, T.: Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann. Surg. 259, 52–71 (2014). CrossRefPubMedGoogle Scholar
  3. 3.
    Kroon, L.A.: Drug interactions with smoking. Am. J. Heal. Pharm. 64, 1917–1921 (2007). CrossRefGoogle Scholar
  4. 4.
    Rigotti, N.A., Munafo, M.R., Stead, L.F.: Smoking cessation interventions for hospitalized smokers: a systematic review. Arch. Intern. Med. 168, 1950–1960 (2008)CrossRefGoogle Scholar
  5. 5.
    Rigotti, N.A., Clair, C., Munafò, M.R., Stead, L.F.: Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst. Rev. 5, CD001837 (2012). CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Ekpu, V.U., Brown, A.K.: The economic impact of smoking and of reducing smoking prevalence: review of evidence. Tob. Use Insights. 8, 1–35 (2015). CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Garber, A. M. Cost-effectiveness and evidence evaluation as criteria for coverage policy. Health Aff. Suppl Web:W4-284–296 (2004). CrossRefGoogle Scholar
  8. 8.
    National Institute for Health and Care Excellence: Smoking cessation in secondary care: cost-effectiveness review. Accessed 10 Oct 2018
  9. 9.
    Drummond, M.F., Jefferson, T.O.: Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 313(7052), 275–283 (1996). CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gøtzsche, P.C., Ioannidis, J.P.A., Clarke, M., Devereaux, P.J., Kleijnen, J., Moher, D.: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339, b2700 (2009). CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Centre for Reviews and Dissemination: Systematic Reviews: CRD’s Guidance for Undertaking Reviews in Health Care. CRD University of York, York (2008)Google Scholar
  12. 12.
    Glanville, J., Fleetwood, K., Yellowlees, A., Kaunelis, D., Mensinkai, S.: Development and Testing of Search Filters to Identify Economic Evaluations in MEDLINE and EMBASE. Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa (2009)Google Scholar
  13. 13.
    Neyt, M., Chalon, P.X.: Search MEDLINE for economic evaluations: tips to translate an OVID strategy into a PubMed one. Pharmacoeconomics. 31(12), 1087–1090 (2013). CrossRefPubMedGoogle Scholar
  14. 14.
    Richardson, W.S., Wilson, M.C., Nishikawa, J., Hayward, R.S.: The well-built clinical question: a key to evidence-based decisions. ACP J. Club 123(3), A12–A13 (1995)PubMedGoogle Scholar
  15. 15.
    The World Bank: Inflation, GDP deflator (annual %). Accessed 14 Feb 2018
  16. 16.
    Organisation for Economic Co-operation and Development (OECD): Purchasing power parities for GDP and related indicators. Accessed 14 Feb 2018
  17. 17.
    Chiou, C.-F., Hay, J.W., Wallace, J.F., Bloom, B.S., Neumann, P.J., Sullivan, S.D., Yu, H.T., Keeler, E.B., Henning, J.M., Ofman, J.J.: Development and validation of a grading system for the quality of cost-effectiveness studies. Med. Care 41(1), 32–44 (2003). CrossRefPubMedGoogle Scholar
  18. 18.
    Husereau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., Augustovski, F., Briggs, A.H., Mauskopf, J., Loder, E., ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force: Consolidated Health Economic Evaluation Reporting Standards (CHEERS)–explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 16(2), 231–250 (2013). CrossRefPubMedGoogle Scholar
  19. 19.
    Evers, S., Goossens, M., de Vet, H., van Tulder, M., Ament, A.: Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria. Int. J. Technol. Assess. Health Care 21(2), 240–245 (2005)CrossRefGoogle Scholar
  20. 20.
    Philips, Z., Ginnelly, L., Sculpher, M., Claxton, K., Golder, S., Riemsma, R., Woolacoot, N., Glanville, J.: Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol. Assess. 8(36), 1–158 (2004)CrossRefGoogle Scholar
  21. 21.
    Krumholz, H.M., Cohen, B.J., Tsevat, J., Pasternak, R.C., Weinstein, M.C.: Cost-effectiveness of a smoking cessation program after myocardial infarction. J. Am. Coll. Cardiol. 22(6), 1697–1702 (1993)CrossRefGoogle Scholar
  22. 22.
    Croghan, I.T., Offord, K.P., Evans, T.W., Schmidt, S., Gomez-Dahl, L.C., Schroeder, D.R., Patten, C.A., Hurt, R.D.: Cost-effectiveness of treating nicotine dependence: the Mayo Clinic experience. Mayo Clin. Proc. 72(10), 917–924 (1997)CrossRefGoogle Scholar
  23. 23.
    Meenan, R.T., Stevens, V.J., Hornbrook, M.C., La Chance, P.A., Glasgow, R.E., Hollis, J.F., Lichtenstein, E., Vogt, T.M.: Cost-effectiveness of a hospital-based smoking cessation intervention. Med. Care 36(5), 670–678 (1998)CrossRefGoogle Scholar
  24. 24.
    Prathiba, B.V., Tjeder, S., Phillips, C., Campbell, I.A.: A smoking cessation counsellor: should every hospital have one? J. R. Soc. Promot. Health. 118(6), 356–359 (1998)CrossRefGoogle Scholar
  25. 25.
    Quist-Paulsen, P., Lydersen, S., Bakke, P.S., Gallefoss, F.: Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease. Eur. J. Cardiovasc. Prev. Rehabil. 13(2), 274–280 (2006)CrossRefGoogle Scholar
  26. 26.
    Ladapo, J.A., Jaffer, F.A., Weinstein, M.C., Froelicher, E.S.: Projected cost-effectiveness of smoking cessation interventions in patients hospitalized with myocardial infarction. Arch. Intern. Med. 171(1), 39–45 (2011)CrossRefGoogle Scholar
  27. 27.
    Mullen, K.-A., Coyle, D., Manuel, D., Nguyen, H.V., Pham, B., Pipe, A.L., Reid, R.D.: Economic evaluation of a hospital-initiated intervention for smokers with chronic disease, in Ontario, Canada. Tob. Control 24(5), 489–496 (2015). CrossRefPubMedGoogle Scholar
  28. 28.
    Barnett, P.G., Wong, W., Jeffers, A., Hall, S.M., Prochaska, J.J.: Cost-effectiveness of smoking cessation treatment initiated during psychiatric hospitalization: analysis from a randomized, controlled trial. J. Clin. Psychiatry 76(10), e1285–e1291 (2015). CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Berndt, N., Bolman, C., Lechner, L., Max, W., Mudde, A., de Vries, H., Evers, S.: Economic evaluation of a telephone- and face-to-face-delivered counseling intervention for smoking cessation in patients with coronary heart disease. Eur. J. Health Econ. 17(3), 269–285 (2016). CrossRefPubMedGoogle Scholar
  30. 30.
    Taylor, C., Houston-Miller, N., Killen, J.D., DeBusk, R.F.: Smoking cessation after acute myocardial infarction: Effects of a nurse-managed intervention. Ann. Intern. Med. 113(2), 118–123 (1990)CrossRefGoogle Scholar
  31. 31.
    Franke, D.L., Leistikow, B.N., Offord, K.P., Schmidt, L., Hurt, R.D.: Physician referrals for smoking cessation: outcome in those who show and don’t show. Prev. Med. (Baltim) 24(2), 194–200 (1995). CrossRefGoogle Scholar
  32. 32.
    Hatziandreu, E.J., Pierce, J.P., Lefkopoulou, M., Lefkopoulou, M., Fiore, M.C., Mills, S.L., Novotny, T.E., Giovino, G.A., Davis, R.M.: Quitting smoking in the United States in 1986. J. Natl. Cancer Inst. 82(17), 1402–1406 (1990)CrossRefGoogle Scholar
  33. 33.
    Hurt, R.D., Offord, K.P., Hepper, N.G.G., Mattson, B.R., Toddie, D.A.: Long-term follow-up of persons attending a community-based smoking-cessation program. Mayo Clin. Proc. 63(7), 681–690 (1988). CrossRefPubMedGoogle Scholar
  34. 34.
    Hurt, R.D., Dale, L.C., Fredrickson, P.A., Caldwell, C.C., Lee, G.A., Offord, K.P., Lauger, G.G., Marŭsić, Z., Neese, L.W., Lundberg, T.G.: Nicotine patch therapy for smoking cessation combined with physician advice and nurse follow-up. One-year outcome and percentage of nicotine replacement. JAMA. 271(8), 595–600 (1994)CrossRefGoogle Scholar
  35. 35.
    Stevens, V.J., Glasgow, R.E., Hollis, J.F., Lichtenstein, E., Vogt, T.M.: A smoking-cessation intervention for hospital patients. Med. Care 31(1), 65–72 (1993)CrossRefGoogle Scholar
  36. 36.
    British Thoracic Society: Comparison of four methods of smoking withdrawal in patients with smoking related diseases. Report by a subcommittee of the Research Committee of the British Thoracic Society. BMJ. 286(6365), 595–597 (1983)CrossRefGoogle Scholar
  37. 37.
    British Thoracic Society: Smoking cessation in patients: two further studies by the British Thoracic Society. Research Committee of the British Thoracic Society. Thorax. 45(11), 835–840 (1990)CrossRefGoogle Scholar
  38. 38.
    Quist-Paulsen, P., Gallefoss, F.: Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease. BMJ 327(7426), 1254–1257 (2003). CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Eisenberg, M.J., Filion, K.B., Yavin, D., Bélisle, P., Mottillo, S., Joseph, L., Gervais, A., O’Loughlin, A., Paradis, G., Rinfret, S., Pilote, L.: Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ 179(2), 135–144 (2008)CrossRefGoogle Scholar
  40. 40.
    Reid, R.D., Mullen, K.A., Slovinec D’Angelo, M.E., Aitken, D.A., Papadakis, S., Haley, P.M., McLaughlin, C.A., Pipe, A.L.: Smoking cessation for hospitalized smokers: an evaluation of the “Ottawa Model”. Nicotine Tob. Res. 12(1), 11–18 (2010). CrossRefPubMedGoogle Scholar
  41. 41.
    World Health Organization: Macroeconomics and Health: Investing in Health for Economic Development: Report of the Commission on Macroeconomics and Health. WHO, Geneva (2001)Google Scholar
  42. 42.
    Schwarzer, R., Rochau, U., Saverno, K., Jahn, B., Bornschein, B., Muehlberger, N., Flatscher-Thoeni, M., Schnell-Inderst, P., Sroczynski, G., Lackner, M., Schall, I.: Systematic overview of cost-effectiveness thresholds in ten countries across four continents. J. Comput. Eff. Res. 4, 485–504 (2015)CrossRefGoogle Scholar
  43. 43.
    EuroQol Group: EuroQol–a new facility for the measurement of health-related quality of life. Health Policy (New York) 16, 199–208 (1990)CrossRefGoogle Scholar
  44. 44.
    Weinstein, M.C., Siegel, J.E., Gold, M.R., Kamlet, M.S., Russell, L.B.: Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 276, 1253–1258 (1996)CrossRefGoogle Scholar
  45. 45.
    Sharpe, T., Alsahlanee, A., Ward, K.D., Doyle, F.: systematic review of clinician-reported barriers to provision of smoking cessation interventions in hospital inpatient settings. J. Smok. Cessat. 13, 233–243 (2018)CrossRefGoogle Scholar
  46. 46.
    Fiore, M.C., Goplerud, E., Schroeder, S.A.: The joint commission’s new tobacco-cessation measures—Will hospitals do the right thing? N. Engl. J. Med. 366, 1172–1174 (2012)CrossRefGoogle Scholar
  47. 47.
    Barua, R.S., Rigotti, N.A., Benowitz, N.L., Cummings, K.M., Jazayeri, M.A., Morris, P.B., Ratchford, E.V., Sarna, L., Stecker, E.C., Wiggins, B.S.: 2018 ACC expert consensus decision pathway on tobacco cessation treatment: A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J. Am. Coll. Cardiol. 72, 3332–3365 (2018)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health ServicesUniversity of WashingtonSeattleUSA
  2. 2.Department of Preventive MedicineKyung Hee University College of MedicineSeoulKorea

Personalised recommendations