Aim and objective:
To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS).

Methods:
We used the EQUIPTMOD a Markov-based state transition economic model, for an Spanish adult smoking population (16+ years), to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios: coverage of proactive phone calls; nicotine replacement therapy (mono and combo) (Rx NRT); varenicline (standard duration); or bupropion; to complement the current provision. A rate of 3% was used to discount lifetime costs and benefits. The measures used were healthcare costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates.

Results:
The cost of implementing the current provision of smoking cessation services is about €61million in the current year. This translates to 18 quitters per 1000 smokers and a lifetime benefit-cost ratio of 5, compared to no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generated more QALYs) from the lifetime perspective, compared to the current provision. The lifetime benefit-cost ratios were: 1.87 (proactive phone calls); 1.49 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis.

Conclusions:
Analysis based on the EQUIPTMOD has provided Spanish decision-makers with policy options for tobacco control. It would be cost-effective to expand the reach of GP brief interventions to all areas of Spain, provide proactive telephone support and reimburse smoking cessation medication to smokers trying to stop. Over a lifetime, these policies would be cost-saving.

Funding:
This project was funded by the European Community's Seventh Framework Programme (The EQUIPT Project; grant agreement 602270). The funders had no influence in the conduction of this study or the drafting of this manuscript.