Cost‐effectiveness of population‐level proactive tobacco cessation outreach among socio‐economically disadvantaged smokers: evaluation of a randomized control trial

Aims To estimate the cost‐effectiveness at population‐level of the OPT‐IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low‐income persons (e.g. Medicaid). Design Cost‐effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT‐IN) randomized control trial. Setting The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective. Participants Data were used from 2406 smokers who were randomized into the intervention or comparator groups. Intervention and comparator The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)‐approved smoking cessation medications and the state's telephone quitline. Measurements Smoking status, quality of life and health‐care use at varying times, including at baseline and 1 year. Findings The OPT‐IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population‐level, 6‐month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P