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Original Research: SMOKING CESSATION |

Cost-Benefit Analysis of a Simulated Institution-Based Preoperative Smoking Cessation Intervention in Patients Undergoing Total Hip and Knee Arthroplasties in France

Gilles Hejblum, PhD; Kokuvi Atsou, MS; Bertrand Dautzenberg, MD; Christos Chouaid, MD
Author and Funding Information

*From INSERM, U707 (Dr. Hejblum); UPMC Univ Paris 06 UMR S 707 (Mr. Atsou); AP-HP, Groupe Hospitalier Pitié-Salpêtrière (Dr. Dautzenberg), Service de Pneumologie et Réanimation; and AP-HP, Hôpital Saint Antoine (Dr. Chouaid), Service de Pneumologie, Paris, France.

Correspondence to: Gilles Hejblum, PhD, INSERM, U707, 27 rue Chaligny, 75012 Paris France; e-mail: gilles.hejblum@inserm.fr


This work was supported in part by Office Français de Prévention du Tabagisme and Direction Générale de la Santé, neither of which had any control over the design, analysis or reporting of the research.

The authors have no financial or other potential conflicts of interest.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):477-483. doi:10.1378/chest.08-0897
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Background:  The literature on preoperative smoking cessation indicates that smoking patients are more likely to have postoperative complications. However, the economic implications of such complications are unclear. In particular, the balance between the cost of a preoperative intervention for smoking cessation (PISC) and the benefit resulting from the potential decrease in hospitalization costs is not known.

Methods:  Only one previous study, a randomized trial involving smokers scheduled for hip or knee replacement surgery, provides sufficient data to simulate the hospital course of patients subjected or not subjected to a PISC. We used a multistate Markov-type model and official French hospital costs for 2008 to simulate this situation. The cost-benefit analysis adopted the payer's perspective.

Results:  The mean benefit, corresponding to the decrease in the cost of the hospital stay for a reference case patient having followed a PISC, was estimated at €313, with a corresponding mean cost of the PISC estimated at €196. Therefore, the PISC was associated with a cost saving of €117 per patient. The results were most sensitive to the cost of ICU care as a proxy for cost of smoking-related complications, and to the relative risk of complication between patients with and without a PISC.

Conclusion:  Under the conditions simulated by this cost-benefit model, potential modest cost savings may accrue with implementation of an institution-based smoking cessation program through reduced total hospitalization costs that exceed the cost of the intervention.

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