Research

Cost-effectiveness of smoking cessation to prevent age-related macular degeneration

Susan F Hurley^1,2,3 , Jane P Matthews¹ and Robyn H Guymer⁴

¹  Bainbridge Consultants, 222/299 Queen St, Melbourne, VIC 3000, Australia

²  School of Medicine, Griffith University

³  School of Population Health, The University of Melbourne

⁴  Macular Research Unit, Department of Ophthalmology, Centre for Eye Research Australia, The University of Melbourne

author email corresponding author email

Cost Effectiveness and Resource Allocation 2008, 6:18doi:10.1186/1478-7547-6-18

Published:	11 September 2008

Abstract

Background

Tobacco smoking is a risk factor for age-related macular degeneration, but studies of ex-smokers suggest quitting can reduce the risk.

Methods

We fitted a function predicting the decline in risk of macular degeneration after quitting to data from 7 studies involving 1,488 patients. We assessed the cost-effectiveness of smoking cessation in terms of its impact on macular degeneration-related outcomes for 1,000 randomly selected U.S. smokers. We used a computer simulation model to predict the incidence of macular degeneration and blindness, the number of quality-adjusted life-years (QALYs), and direct costs (in 2004 U.S. dollars) until age 85 years. Cost-effectiveness ratios were based on the cost of the Massachusetts Tobacco Control Program. Costs and QALYs were discounted at 3% per year.

Results

If 1,000 smokers quit, our model predicted 48 fewer cases of macular degeneration, 12 fewer cases of blindness, and a gain of 1,600 QALYs. Macular degeneration-related costs would decrease by $2.5 million if the costs of caregivers for people with vision loss were included, or by $1.1 million if caregiver costs were excluded. At a cost of $1,400 per quitter, smoking cessation was cost-saving when caregiver costs were included, and cost about $200 per QALY gained when caregiver costs were excluded. Sensitivity analyses had a negligible impact. The cost per quitter would have to exceed $77,000 for the cost per QALY for smoking cessation to reach $50,000, a threshold above which interventions are sometimes viewed as not cost-effective.

Conclusion

Smoking cessation is unequivocally cost-effective in terms of its impact on age-related macular degeneration outcomes alone.