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I COST-E: rECTIVE:VESS kYD BE:VEFITS OF S'M0KE SiCPPERS PRCGRAM AS CCMPARED TO 7VO OTHER POPULkR RtOKI:lG CESSATICN PROGRAMS* The attached analysis was done for St. Joseph Mercy Hospital in Ann Arbor, Michigan in order to document the benefits to that hospital of having 120 employees and 5 of their spouses participate in the Smoke Stoppers.smok- ing cessation program. The analysis comoares the outcomes and savings of the Smoke Stopoers-program with the other two programs in order to determine which of the three is the most cost-effective. The analysis highlights several important findings: 1. The efficacy of Smoke Stoppers (320) clearly exceeds that of two other popular area programs. A graduate student in Public Health Education did a follow-up study on the participants who had been out of the program for more than a year to determine this percen- tage. Most programs cited in the literature report 20-25% effi- cacy; frequently this is a vastly overestimated figure as they - do not include in their percentage those clients whom they could not reach. The 32% figure accounts for all clients who have been out of the program for a year. 2. The literat-sre states that of all those smokers who want to quit only about 2% attend a formal program such as Smoke Stoppers. The 4.6% effectiveness (impact divided by need) is high when we consider the former statistic. 3. Program costs have been kept to a minimum for three reasons: a. Smoke Stoppers' willingness to offer the program to the hos- pital at a reduced fee b. their cancellation of the hospital's contribution to the em- ployees' fee c. their willingness to assume costs for secretarial time, pub- licity, etc. As we can see, running Program A would have cost the hospital about three times as much. With Progr= B the costs would have been about 4h times as much. Smoke Stoppers is clearly the most efficient program. 4. Not only is Smoke Stoppers efficient, it is also cost-effective. This is surprising, because although group teaching methods are usually more efficient, they are not always more effective (1:1 counselling is usually more effective). It is remarkable to see that a similar outcome with Program B, a 1:1 counselling program, would have cost us about 7~ t:Cmes as much. , I a I I ~ d I I E 1.. L L *Subatit'.s3 by Am Quigley, Flealth Fducatar, St. Joserh Mercy Hos-Dit:al, Ann Arbor ~ C1T 0~ L -202- O

I U Researi:h has doc,.mtented that non-smokers .ive seven years longer than smokers and r,ui a lesser risk of acquiring certain chronic conditions such as lung cancer or emphysema. Nonetheless, these benefits are not immediate, and we would need a long-term pro- spective study to measure them. However, there are two i.=ediately tangible benefits which we can calculate. a. savings to the hospital for not having to pay wages for sick time b. savings to the employees who no longer buy cigarettes 6. In calculating_just the two benefits described above, we can see that after one year, for each $1 invested in the Smoke Stoppers program, $3.60 has been recovered as a benefit. This is a very favorable cost-benefit ratio when compared to the other two pro- g='sms Over time and with further study it should be possible to document the savings from a. fires prevented (Smoking is the second most frequent cause of fires in homes.) b. deereased hospitalization (Smokers are hospitalized 1h times more than non-smokers.) Adding these cost savings to the savings mentioned in Sa and Sb, it will be possible to demonstrate an even more favorable cost-benefit ratio than 3.6/1. -203-

*Cost-Effectiveness and Cost-Benefit Computations for Smoke Stoppers Program Compared to Two Othor Popular Smoking Cessation Programs Smoke Stoppers Prograw A Program 8 A. Need (estimated population eligible) 8751 8751 8751 B. Reached (attended)2 125 1253 1253 C. Coverage (R/A x 100) 14% 14% 14% D. Impact4 40 345 256 i @. Efficacy (D/8) 32% 27X 20% F. Effectiveness (D/A) 4.6X 7 3.9% 2.9% C. 1'rograiu CoatB $ 4,820.00 $13,603.50 $22,672.50 11. I. I:fficlency (C/g) Coat-effectiveness (G/D) $ 38.56/client $ 120.50/outcome $ 108.83/elient $ 400.10/outcome $ 181.38/cllent $ 906.90/outcome J. Uenefita 9 $ 943.20 savings in lost work days $16,352.00 savings from not buying cigarettes $ 801.72 savings in lost work days $13,899.20 savings from not buyiny cigarettes $ 589.50 savinEs in lost work daya $10,220.00 savJngs from tiot buyJng c1gilreLtcs K. Cost/benefit (J/C)t0 3.6/1 1.1/1 ,5/1 0509V9SA • Computations done for St. Joseph Morcy Hospital, Ann Arbor, Michigan by Aiuno4 (hilgluy. August 28, 1980. ...._ ...... ..,OM r--- ~-- f.~... ...... ~-- ~--- L,~`--- r---- ~-- r--- rw

1 Out of 2,624 SJMII employees, approximately 1/3 (875) are smokers, according to national utatistics. Total attendanca of St. Joseph 1lercy tiospital employees and spouses in Smoke Stoppers program from 1-1-79 to 12-31-79. 2 3 Ilypothetical attendance if program had been held at SJMI1. 4lmpact - outcome - client who has maintained non-amoking behavior for at 5 Uased on program success rate of 27%, as documented in the literature. 6 lfnsell on program success rate of 20%, as documented in the literature. 7'fhls ia a high least one year. effectiveness rate when one considers that only 2% of those programe such as this. who want to quit amoking attend fornal OCost - contributions paid by SJl4i for each employee and spouse who went through progrnm. Hospital paid 69X of fee for euch employee and 50% of fee for each spouse, until September 1979 at which time Smoke Stoppers waived the hospital's contribution. Therefore, the hospital paid a partial fee for 84 employees and 5 spouses. Had the hospital utilized Program A or Program B, the same percentage probably would have applied. However, their program costa would have been higher. For example: Smoke Stoppers $ 80/client Program A $225/client Program B $375/client (based on a minimum of 3 sessions at $125/session) Also, it is not known whether or not Program A and Program B would have cancelled the hospital's contribu- tion in September. These statistics are based on the conjecture that they might have done so, due to SJM1I support and number of progrum enrollees. However, cancellation of the hospital's contribution clearly wukes the Smoke Stoppers program all the aore cost effective for the hospital to run. 'i'Iiere are no otlier program cnacs. All costs for secretarial time, publicity, room rental, etc., are billed co Smoke Stoppers. 91(eduction in costs due to deaths and disabilities ia very speculative. These are long-terru benefit5 which can only be measured by a prospective study. Therefore, take tangible benefits which can be measured immediately, auch as a) Suvin6s in lost-work days (1 smoker quits smoking - 3 lost work days saved per year) (benefit to the hospital) (as docuunented by an I1.@.W. study) b) Savings from not buyinp, cigarettes (before the program clients smoked 14 packs cigarettes/day) Calculate on basis of 1 pack cigarettes - 75C- (benefit to tlie progrum participants) ' TS0969S9

3 I For example, with Smoke Stoppers 40 employees stopped emoking x 3 120 work days saved x 7.86/hr (average hourly rate for employees) $943.20 saved by hospital 10 Cost benefit ratio for Smoke Stoppers,reade: For each $1 invested in the program, $3.60 are saved. Therefore, the higher the number in the numerator, the greater the coet-benefit. The cost benefit ratio should be at least 1/1 for a program to break even. With hypnosis this is not the case. For each $1 invested in the pro6ram, only 50C iy recovered as a benefit. 1 zsosPsse , •_ r--- E::~r---- r-- ~-.- r--- ~- r-- Q.-