Cost of Providing Telephone Case Management for Smoking Cessation

Takahashi NY, Vivell S, Martinez G, Sherman SE. Cost of Providing Telephone Case Management for Smoking Cessation. Paper presented at: VA HSR&D National Meeting; 2004 Mar 10; Washington, DC.

Objectives: Health care organizations are increasingly interested in tobacco control, but are unsure how best to allocate resources. Both cost and effectiveness vary dramatically between primary care-based treatment, telephone counseling and intensive smoking cessation programs. We calculated the cost of a telephone care coordination program (TCCP) for smoking cessation, and compared it with other treatment approaches.Methods: TCCP is a demonstration project to increase referrals to a free state Quitline for smoking cessation. Patients receive 5-7 calls over 2 months, providing counseling and medication management for smoking cessation. We separated the cost/patient into: 1) telephone counseling time, 2) administrative time, 3) physician time, 4) pharmacist time, and 5) medication cost. We compared this to the cost of treatment within primary care or within a smoking cessation program, factoring in counseling duration, likelihood of attending a smoking cessation program, and success rate.Results: The cost for a full treatment course for TCCP was $158.75 ($38.75 for staff time and $120 for medications) vs. $153.75 within primary care or $157.50 within a smoking cessation program. The cost to produce one successful quitter, however, was significantly lower for TCCP ($293/quitter) than for the smoking cessation program ($418/quitter) or primary care-based treatment ($650/quitter).Conclusions: The cost/quitter was lowest for TCCP and highest for primary care-based treatment.Impact: The costs of various forms of smoking cessation treatment are essential to an organized approach to tobacco control. Telephone counseling is a reasonably priced alternate approach to providing effective care, improving access, and leveraging physician time.