Cost‐effectiveness of a specialist smoking cessation package compared with standard smoking cessation services for people with severe mental illness in England: a trial‐based economic evaluation from the SCIMITAR+ study

Abstract

Aims To evaluate the cost‐effectiveness of a specialist smoking cessation package for people with severe mental illness Design Incremental cost‐effectiveness analysis was undertaken from the UK National Health Service and Personal Social Services perspective over a 12 month time horizon. Total costs, including smoking cessation, healthcare and social services costs, and quality‐adjusted life years (QALYs), derived from EQ‐5D‐5L, collected from a randomised controlled trial, were used as outcome measures. Bootstrap technique was employed to assess the uncertainty. Setting Sixteen primary care and 21 secondary care mental health sites in England Participants Adult smokers with bipolar affective disorder, schizoaffective disorder or schizophrenia and related illnesses (n=526). Intervention and comparator A bespoke smoking cessation (BSC) package for people with severe mental illness offered up to 12 individual sessions with a mental health smoking cessation practitioner versus usual care (UC). Of the participants who were randomised, 261 were in UC group and 265 were in BSC group. Measurements BSC intervention cost was estimated from treatment log. Costs of UC, healthcare and social services, and EQ‐5D‐5L were collected at baseline, six‐ and 12‐month follow‐ups. Incremental costs and incremental QLAYs were estimated using regression adjusting for respective baseline values and other baseline covariates. Findings The mean total cost in the BSC group was £270 (95% CI ‐£1,690 to £1,424) lower than in the UC group while the mean QALYs were 0.013 (95% CI ‐0.008 to 0.045) higher, leading to BSC dominating UC (76% probability of cost‐effective at £20,000/QALY). Conclusions A bespoke smoking cessation package for people with severe mental illness is likely to be cost‐effective over 12 months compared with usual care provided by the UK's National Health Service and personal social services.