Smoking is a major cause of avoidable morbidity and mortality in the United States. While over 70% of smokers would like to quit smoking, fewer than 10% succeed in quitting. Recently, the SLC6A3 gene has been found to predispose smokers to nicotine dependence. A companion clinical trial (Project 2) proposed in this TTURC grant application will determine the efficacy of transdermal nicotine patches (TN) and nicotine nasal spray (NS) in smokers with protective and predisposing SLC6A3 genotypes. However, the long-term health outcomes and costs of care associated with these cessation strategies are not known. To address this important gap, the investigators will use cost-effectiveness analysis to examine costs and outcomes of three strategies for smoking cessation. 1) using counseling and TN for all smokers making a quit attempt; 2) using counseling and NS for all smokers attempting to quit; and 3) gene testing all smokers making a quit attempts, and tailoring treatment such that those with protective genotypes receive counseling and T, and those with predisposing genotypes receive counseling and NS.
The specific aims of the study are 1) to collect health preference data from participants of a randomized clinical trial of NS versus TN to test the hypothesis that successful quitters have higher health-related quality of life than those making unsuccessful quit attempts, and 2) to perform a cost-effectiveness analysis incorporating health preference data from aim (1), longevity, and costs to test the hypothesis that using SLC6A3 gene testing to tailor therapy will be cost-effective compared to treatment of all smokers with either TN or NS. The proposed study will have two components. First, health-preference data will be collected on at least 700 smokers enrolled in the clinical trial (Project 2). Second, a computer simulation model will be constructed which incorporates smokers' health preferences, clinical trial data from Project 2 on cessation rates for TN and NS stratified by gene status and medial literature data on longevity based upon smoking status. This model will calculate the long-term costs and outcomes of the three cessation strategies. Results will be presented as incremental cost- effectiveness ratios with units of cost per quality-adjusted life year saved and cost per successful quit. The proposed study represents an innovative approach to the rapid assessment of SLC6A3 gene testing. Data from this proposal will provide a framework for health policy guidelines that maximize the health of the smoking population for an acceptable cost.
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