Project to be completed by Nadine Berndt, PhD student in Health Psychology (Open University of the Netherlands, nadine.berndt@ou.nl) under the supervision of prof. dr. Wendy Max at the Institute of Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco

Rationale: Giving up smoking after hospitalization for a cardiac disease improves prognosis more than any other treatment. However, by some estimates, over half of those patients who smoked prior to a cardiac event persist in smoking or relapse after hospital discharge. Although there are evidence-based smoking cessation interventions available for cardiac patients, they show small effects and do not optimally fit the cardiac ward practice. Besides, the economic impact of these interventions has not been well evaluated.
Objectives: This study started in 2009 and is still in progress. It examines within the cardiac inpatient setting the cost-effectiveness of two smoking cessation counseling methods combined with nicotine replacement therapy (NRT). The counseling is delivered outside the ward either by telephone (TC) or face-to-face (FC). The effectiveness study specifically compares health and smoking cessation outcomes, while the cost-effectiveness study compares the health outcomes with costs of the interventions, and assesses their budgetary impact. Cost-effectiveness analyses will be performed for different subgroups of smokers, namely smokers motivated to quit and smokers with a low socio-economic status (SES). It is expected that FC, which is more expensive, is more effective in low SES groups. TC is cheaper and expected to be more effective in smokers motivated to quit.
Methods: In 8 hospital cardiac wards throughout the Netherlands, 626 cardiac patients who smoked prior to admission were recruited. An experimental cross-over design with a baseline measurement and two follow-up measurements after 6 and 12 months is used. At hospital admission, nurses assessed patients’ smoking behavior, ensured a quit advice and referred patients in the experimental conditions to FC or TC. Both counseling methods continued for 3 months. The primary outcome measures at 6 and 12 month follow-up are patients’ reported 7-day smoking abstinence, incremental costs per quitter and incremental costs per QALY. Preliminary results: 245 patients were included in the usual care group, 157 in the FC group and 224 in the TC group. Patients were predominantly male with a mean age of 57 years and mostly had admission diagnosis of acute coronary syndrome. The preliminary results at 6 months show that half (49.9%) of all patients (complete cases analyses) quit smoking. In the FC group (61%) and the TC group (56%) significant more patients quit smoking than in the usual care group (42%) (χ²=10.95; p=.004).
Discussion: The combination of FC or TC and NRT has the potential to be cost-effective to help patients to quit smoking after hospitalization for a cardiac event. The 6 months economic evaluation study will be conducted during my visit to the institute of Health and Aging at the University of California, San Francisco under supervision of prof. dr. Wendy Max.

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