Cost-effectiveness of personal tailored risk information
and taster sessions to increase the uptake of the NHS stop
smoking services: the Start2quit randomized controlled
, Hazel Gilbert
, Irwin Nazareth
, Stephen Sutton
, Irene Petersen
Department of Health Sciences, University of York, York, UK,
Research Department of Primary Care and Population Health, UCL, London, UK,
Institute of Public Health,
University of Cambridge, Cambridge, UK
and Smokefree Camden (Public Health), NHS Camden, London, UK
To assess the cost-effectiveness of a two-component intervention designed to increase attendance at the NHS
Stop Smoking Services (SSSs) in England.
Cost-effectiveness analysis alongside a randomized controlled trial
NHS SSS and general practices in England.
The study comprised 4384 smokers aged
16 years or more identiﬁed from medical records in 99 participating practices, who were motivated to quit and had not
attended the SSS in the previous 12 months.
Intervention and comparator
Intervention was a personalized and tailored
letter sent from the general practitioner (GP) and a personal invitation and appointment to attend a taster session providing
information about SSS. Control was a standard generic letter from the GP advertising SSS and asking smokers to contact the
service to make an appointment.
Costs measured from an NHS/personal social services perspective,
estimated health gains in quality-adjusted life-years (QALYs) measured with EQ-5D and incremental cost per QALY gained
during both 6 months and a life-time horizon.
During the trial period, the adjusted mean difference in costs was
£92 [95% conﬁdence interval (CI) = –£32 to –£216) and the adjusted mean difference in QALY gains was 0.002 (95%
CI = –0.001 to 0.004). This generates an incremental cost per QALY gained of £59 401. The probability that the tailored
letter and taster session is more cost-effective than the generic letter at 6 months is never above 50%. In contrast, the
discounted life-time health-care cost was lower in the intervention group, while the life-time QALY gains were signiﬁcantly
higher. The probability that the intervention is more cost-effective is more than 83% using a £20 000–30 000 per QALY-
gained decision-making threshold.
An intervention designed to increase attendance at the NHS Stop
Smoking Services (tailored letter and taster session in the services) appears less likely to be cost-effective than a generic letter
in the short term, but is likely to become more cost-effective than the generic letter during the long term.
Keywords Cost-effectiveness, personal tailored risk information, randomized controlled trial, smoking cessation, stop
smoking services, uptake of service.
Correspondence to: Qi Wu, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK. E-mail: firstname.lastname@example.org
Submitted 20 December 2016; initial review completed 8 May 2017; ﬁnal version accepted 24 October 2017
Smoking is the greatest avoidable cause of mortality and
morbidity, and a major public health problem in the
United Kingdom [1,2]. Half of smokers will die prematurely
due to smoking-related disease, such as lung cancer,
chronic obstructive pulmonary disease (COPD) or coronary
heart disease (CHD), and lose an average of 8 years of life
. The prevalence of smoking in the United Kingdom
has dropped from 45% in the 1960s to 19% in 2013;
however, the reduction has slowed during the past 5 years
. The NHS spends more than £5 billion a year on
treating smoking-related diseases, and the societal cost of
smoking is approximately £14 billion a year when loss of
productivity and economic output due to smoking-related
illness and premature death are taken into account [5,6].
Government-funded specialist smoking cessation ser-
vices, now known as the NHS Stop Smoking Services
(SSSs), were established by Primary Care Trusts (PCTs)
throughout England in 2000 . The SSSs provide free,
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© 2017 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction. Addiction, 113,708–718