JMIR Publications

ABSTRACT

Background:

Smoking cessation (SC) interventions may contribute to better treatment outcomes, prevention of recurrent or second cancers and the general wellbeing of cancer survivors.

Objective:

To evaluate the effectiveness, cost-effectiveness, and cost-utility of a digital interactive SC intervention compared to a non-interactive online information brochure for cancer survivors, in a pragmatic randomised controlled trial.

Methods:

A health economic evaluation alongside a pragmatic two-arm parallel-group randomised controlled trial (RCT) with a baseline assessment and follow-ups at 3, 6 and 12 months post baseline comparing the SC intervention with the information brochure. The study was conducted over the Internet, from November 2016 to September 2019. Participants were Dutch adult cancer survivors who were current smokers with the intention to quit smoking. In total, 165 participants were included and analysed; 83 in the intervention group and 82 in the control group. In the intervention group, participants had access to a newly developed, interactive, digital, minimally guided SC intervention “MyCourse-Quit Smoking”. In the control group, participants received a non-interactive online information brochure on SC with unrestricted access to usual care. Primary outcome was self-reported 7-day smoking abstinence at 6-month follow-up. Secondary outcomes were quality adjusted life years (QALYs) gained, number of cigarettes smoked, nicotine dependence, and treatment satisfaction at 3, 6 and 12 months post baseline. For the health economic evaluation, healthcare costs, and societal costs (including productivity losses) were assessed.

Results:

At 6-month follow-up the quit rates were 27.7% (n=23) and 25.6% (n=21) in the experimental and control groups, respectively (OR = 0.47 95%CI 0.03 to 7.86, P = .60). In both groups nicotine dependence scores were reduced at 12 months and the number of smoked cigarettes was reduced roughly by half. The number of cigarettes decreased more over time and the experimental group demonstrated a significantly greater reduction at 12-month follow-up (IRR = 0.87, 95%CI 0.76 to 1.00, P = .04). Intervention costs were estimated at US$ 193 per participant for the experimental group and at US$ 74 for the control group. Mean per-participant societal costs were US$ 25,329 and US$ 21,836, respectively. In the cost-utility analysis, the MyCourse intervention was not preferred over the control condition when taking the societal perspective. In addition, with actual smoking behaviour as the outcome, the experimental condition led to marginally better results per reduced pack-year against higher societal costs, with a mean incremental cost-effectiveness ratio (ICER) of US$ 52,067.

Conclusions:

At 6 months, both conditions led to approximately a quarter of the cancer survivors quitting smoking, 50% reduction in the number of cigarettes smoked, with no significant differences between the conditions. At 12 months, the MyCourse intervention led to a greater reduction of number of smoked cigarettes at higher costs compared to the control condition. No evidence was found for a differential effect on cessation rates or QALYs. Clinical Trial: Trial registration number: The trial was registered in The Netherlands Trial Register (NTR): NTR6011, https://www.trialregister.nl/trial/5434 on 1 September 2016.