Objectives: To describe some of the costs of providing a smoking-cessation program in a community pharmacy practice, and to model the program's cost-effectiveness compared with that of a self-directed quit attempt.
Design and setting: Data used were based primarily on results from a pharmacist-directed smoking-cessation program in a community pharmacy chain practice that achieved continuous abstinence for at least 1 year in 25% of patients. Baseline assumptions were formulated from a MEDLINE literature review and were varied in the sensitivity analysis. Overall costs were based on program costs and retail cost of the selected cessation method (cold turkey, nicotine patch, nicotine gum, or bupropion).
Patients: Forty-eight patients, more than two thirds of whom were women, aged 21-70 years, who had tried at least once to quit smoking.
Measurements and main results: Incremental cost-effectiveness was measured in terms of cost/successful quit attempt based on the payer's perspective. Cost/life-year saved and cost/quality-adjusted life-year saved also were calculated for the societal perspective. Incremental cost for an additional patient to quit smoking using the pharmacist-directed program alternatives versus a self-directed quit attempt was $236 for the cold turkey method, $936 for nicotine patch, $1232 for nicotine gum, and $1150 for bupropion. Depending on the smoker's age at the time of cessation, the incremental discounted cost-effectiveness was $720-1418/life-year saved.
Conclusion: This analysis demonstrates that a pharmacist-directed cessation program is a cost-effective alternative to a self-directed quit attempt with respect to payers and society. Additional analyses conducted in community pharmacy practice are necessary to corroborate our results.