Health, Healthcare, and Economic Impacts of Hospital-initiated Smoking Cessation Interventions

Title: Health, Healthcare, and Economic Impacts of Hospital-initiated Smoking Cessation Interventions
Authors: Mullen, Kerri
Date: 2015
Abstract: Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalization and re-hospitalization. Smoking cessation leads to improved morbidity and reduced risk of death. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. Despite this, few Canadian hospitals have in place policies, protocols, and reminder systems that support the consistent and effective identification and treatment of tobacco users. The Ottawa Model for Smoking Cessation (OMSC), developed at the University of Ottawa Heart Institute (UOHI), is a systematic approach to identifying and treating smokers in the hospital setting. In order for health care funders and hospital administrators to begin supporting effective prevention interventions, like the OMSC, a compelling cost-effectiveness argument must be made. Few studies have looked at the downstream health, health care, and cost implications of such programs, particularly in the Canadian context and none using actual health care administrative data. In response to this gap, three studies were completed, applying theories and methodologies related to health services and population health research. Study 1: From the hospital payer’s perspective, what is the short-term (one year) and long-term (lifetime) cost-effectiveness of the OMSC intervention, as compared to a usual care condition, among high-risk smokers with chronic diseases? A cost-effectiveness analysis was completed based on a decision-analytic model to assess smokers hospitalized in Ontario, Canada for acute myocardial infarction, unstable angina, heart failure, and chronic obstructive pulmonary disease, their risk of continuing to smoke, and the effects of quitting on re-hospitalization and mortality over a one year period. Short- and long-term cost-effectiveness ratios were calculated. The primary outcome was one-year cost per quality-adjusted life year (QALY) gained. Study 2: What are the effects of the OMSC intervention on: 1) mortality, and 2) downstream health care utilization? An effectiveness study was completed comparing patients who received the OMSC intervention (n=726) to usual care controls (n=641). The study took place at 14 hospitals in Ontario. Baseline data was linked to Ontario health care administrative data. Unadjusted and adjusted competing-risks regression models were constructed, clustered by hospital, to compare the cumulative incidence of death, re-hospitalization, emergency department (ED) visits, and physician visits at 30 days, one, and two years following index hospitalization between groups. Study 3: From the health system perspective, what are the cumulative mean health care costs at 30-day, 1-year, and 2-year follow-up among smoker-patients that receive the OMSC compared to those that do not? What are the predictors of direct health care costs for patients that receive the OMSC compared to those who do not? Expanding on Study 2, a cost-analysis was completed to assess 30-day, 1-year, and 2-year health care costs between intervention and control groups. Costs were broken down by service type (e.g. inpatient, ED visits, laboratory, physician visits). To calculate cumulative mean costs, costs were grouped into the study’s 24 monthly intervals and weighted by the inverse probability of not being censored at the beginning of each month. Covariate-adjusted generalized linear models were performed for each of the 24 monthly intervals to determine the association between independent variables and health care costs.
CollectionThèses, 2011 - // Theses, 2011 -