Objective.-To determine the incremental cost-effectiveness of the transdermal nicotine patch. Design.-Decision analytic model that evaluated the incremental cost-effectiveness of the addition of the nicotine patch to smoking cessation counseling. Costs were based on physician time and the retail cost of the nicotine patch, and benefits were based on quality- adjusted life years (QALYs) saved. Patients.-Male and female smokers aged 25 to 69 years receiving primary care. Intervention.-Addition of the nicotine patch to physician-based smoking cessation counseling. Main Outcome Measure.- Costs (1995 dollars) per QALYs saved discounted by 3% annually. Results.-The use of the patch produced 1 additional lifetime quitter at a cost of $7332. The incremental cost-effectiveness of the nicotine patch by age group ranged from $4390 to $10 943 per QALY for men and $4955 to $6983 per QALY for women. A clinical strategy involving limiting prescription renewals to patients successfully abstaining for the first 2 weeks improved the cost-effectiveness of the patch by 25%. Conclusions.-The findings provide support both for the routine use of the nicotine patch as an adjunct to physicians' smoking cessation counseling and for health insurance coverage of nicotine patch therapy.
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