Cost-effectiveness analysis for implementation of smoking cessation strategies at primary health care settings in Tamil Nadu

Background: Smoking is a major public health concern in Tamil Nadu, as it is in many parts of the world. It is a leading cause of preventable diseases and deaths, with a significant economic burden on healthcare systems and society as a whole. Recognizing the need to address this issue, the implementation of smoking cessation strategies at primary health care (PHC) settings has gained attention. Conducting a cost-effectiveness analysis in this context can help policymakers and healthcare providers make informed decisions about the allocation of resources for such interventions. Objectives: To compare the cost-effectiveness of the smoking cessation of proposed strategies (PSs), PS1: enhanced counselling (EC) + nicotine replacement therapy (NRT) + bupropion tablet; PS2: behavioural intervention (BI) + NRT + promotion of bupropion sustained release (SR); PS3: EC + NRT + promotion of bupropion SR with the current strategy (BI +NRT+ Bupropion) in a population of smokers aged ≥15 years attending the PHC in Tamil Nadu. Methods: In this hypothetical cohort of 100,000 individuals using the decision tree analysis, a cost-effectiveness assessment was conducted for both proposed and existing strategies. The results were evaluated in terms of incremental cost-effectiveness ratios (ICERs) per person quitting smoking. To assess the robustness of the findings, one-way sensitivity analysis and probabilistic sensitivity analysis were performed which aims to explore and address the uncertainties associated with the outcomes. Results: The cost of the current strategy (CS) was higher (₹359 or $4.28 million) when compared with PS1 (₹327 or $3.90 million) and PS3 (₹327 or $3.90 million) strategies. The PS2 with BI + bupropion SR + NRT was found to be more cost (₹2,720,571 or $ 32,414.76) as compared to current strategy. ICER values indicates that compared to the current strategy, the PS1 and PS3 were found to be cost-saving, whereas the PS2 was found to be cost-effective. The cost-effectiveness acceptability curve demonstrated that the PS1 and PS3 indicates 100% probability of the intervention being cost-saving. After excluding dominated interventions (PS2 and CS), the remaining strategies (PS1 and PS3) were compared. The PS3, with an incremental cost of ₹462,497 ($5,510) for 131 additional quitters, resulted in an ICER of ₹3,531 ($42) per quitter, making it a cost-effective option compared to PS1. Conclusion: Our study findings indicate that the need for healthcare providers and policymakers to implement PS3 with EC, NRT, Bupropion SR, as which was found to be cost-saving compared to current practices.