© 2005 Society for the Study of Addiction doi:10.1111/j.1360-0443.2005.01071.x Addiction, 100 (Suppl. 2), 70 – 83 Blackwell Science, LtdOxford, UKADDAddiction0965-2140© 2005 Society for the Study of Addiction 1007083 Original Article Cost-effectiveness of English smoking cessation services Christine Godfrey et al. Correspondence to: Christine Godfrey Department of Health Sciences and Centre for Health Economics Area 2 Seebohm Rowntree Building Alcuin College University of York York YO10 5 DD, UK. E-mail: cg2@york.ac.uk RESEARCH REPORT The cost-effectiveness of the English smoking treatment services: evidence from practice Christine Godfrey 1 , Steve Parrott 2 , Tim Coleman 3 & Elspeth Pound 4 Department of Health Sciences and Centre for Health Economics, University of York 1 , Centre for Health Economics, University of York 2 , Division of Primary Care, University of Nottingham 3 and Centre for Research in Social Policy, Loughborough University, Loughborough, UK 4 ABSTRACT Aims To investigate the cost-effectiveness of English specialist smoking cessa- tion services. Design Combination of observational cost and outcome data from English smoking cessation services to calculate cost-effectiveness ratios. Multivariate analysis of factors influencing variation in services’ cost-effectiveness. Setting Fifty-eight of the 92 specialist smoking cessation services in England in 2000/01. Methods Services’ costs were estimated using survey data which described services’ configurations, staffing, interventions delivered and development. Information on services’ throughput and outcomes (as biochemically validated 4-week smoking cessation rates) were obtained from routine sources. With ref- erence to relevant literature and assumptions about relapse and background cessation rates, 4-week cessation rates were converted first to 1-year rates. One- year cessation rates were adjusted to reflect the likely permanent smoking ces- sation rate attributable to service intervention and finally attributable life-years gained were calculated. A wide variety of sensitivity analyses was performed to test the robustness of the average cost-effectiveness ratio, calculated by combin- ing the cost and life-year gained estimates, for all services. With additional data on deprivation levels in services’ areas, ordinary least-squares regression tech- niques were used to investigate variations in individual services’ costs per client and cost-effectiveness ratios. Findings Using an up-to-date estimate for health gain accrued by stopping smoking, the average cost per life gained was £684 (95% CI 557–811), falling to £438 when savings in future health-care costs were counted. With the worst case assumptions, the estimate of cost-effectiveness rose to £2693 per life-year saved (£2293 including future health-care costs) and fell to £227 (£102) under the most favourable assumptions. Findings are comparable to previous pub- lished studies. The regression results suggest that different factors influence cost per client and the net cost per life-year saved, indicating that decision makers should be careful in setting performance targets for these services. Conclusions In 2000/01, English smoking cessation services provided cost- effective services operating well below the benchmark of £20 000 per quality- adjusted life-year saved (QALY) that is used by the National Institute for Clinical Excellence in the United Kingdom. KEYWORDS Cost-effectiveness, nicotine addiction treatment, smoking cessation services.