Cost-Effectiveness of Community Pharmacist-Led Smoking Cessation Programs (2015–2025): A Meta-Analysis Review
DOI:
https://doi.org/10.57218/jkj.Vol4.Iss4.2020Kata Kunci:
Community pharmacy services, Cost benefit analysis, Health economics, Pharmacists, Smoking cessationAbstrak
To systematically review the types of economic evaluations used for community pharmacist-delivered smoking cessation programs and to conduct a meta-analysis of their clinical effectiveness. Methods A systematic search was conducted in PubMed, Scopus, Science Direct, EBSCO, and ProQuest for studies published between 2015 and 2025. The participant criteria are active smokers aged over 18 years, not limited by gender, and the program focuses on community settings. Full economic evaluations of pharmacist-led smoking cessation programs for adults were included. Study quality was assessed using the CHEERS 2022 checklist. Clinical effectiveness data were pooled using a random-effects meta-analysis. The protocol was registered with PROSPERO (CRD420251117242). Results out of 681 identified records, four studies met the inclusion criteria, encompassing more than 1,300 participants. Interventions were conducted in Spain, Canada, Malaysia, and the USA. The majority used cost-effectiveness analyses and reported significant improvements in smoking cessation rates. Meta-analysis showed that pharmacist-led programs significantly improved quit rates (pooled OR = 2.74; 95% CI: 1.83–4.11; p < 0.001) with low heterogeneity (I² = 8.8%). ICERs were consistently below accepted cost-effectiveness thresholds. Based on a threshold analysis using a WTP of CAD$20,000 per QALY, the intervention by Phillips et al. remains cost-effective. The intervention would remain below the threshold unless total costs increased by 23.6% or QALY gains reduced by more than 18%. Conclusion community pharmacist-delivered smoking cessation programs are a clinically effective and economically favorable public health strategy. Policymakers should consider establishing reimbursement models to facilitate their broader implementation.
Referensi
Attema, A. E., Brouwer, W. B. F., & Claxton, K. (2018). Discounting in Economic Evaluations. In PharmacoEconomics (Vol. 36, Issue 7, pp. 745–758). Springer International Publishing. https://doi.org/10.1007/s40273-018-0672-z
Bagepally, B. S., Chaikledkaew, U., Chaiyakunapruk, N., Attia, J., & Thakkinstian, A. (2022). Meta-analysis of economic evaluation studies: data harmonisation and methodological issues. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-07595-1
Brown, T. J., Todd, A., O’malley, C., Moore, H. J., Husband, A. K., Bambra, C., Kasim, A., Sniehotta, F. F., Steed, L., Smith, S., Nield, L., & Summerbell, C. D. (2016). Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation. BMJ Open, 16(6). https://doi.org/10.1136/bmjopen-2015
Cantor, S. B., Deshmukh, A. A., Luca, N. S., Nogueras-González, G. M., Rajan, T., & Prokhorov, A. V. (2015). Cost-effectiveness analysis of smoking-cessation counseling training for physicians and pharmacists. Addictive Behaviors, 45, 79–86. https://doi.org/10.1016/j.addbeh.2015.01.004
Carson-Chahhoud, K. V, Livingstone-Banks, J., Sharrad, K. J., Kopsaftis, Z., Brinn, M. P., To-A-Nan, R., & Bond, C. M. (2019). Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2019(10). https://doi.org/10.1002/14651858.cd003698.pub3
Drummond, M. F., Sculpher, M. J., Klaxton, C., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the Economic Evaluation of Health Care Programmes (4th ed.). Oxford University Press.
Feirman, S. P., Glasser, A. M., Teplitskaya, L., Holtgrave, D. R., Abrams, D. B., Niaura, R. S., & Villanti, A. C. (2016). Medical costs and quality-adjusted life years associated with smoking: A systematic review. In BMC Public Health (Vol. 16, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s12889-016-3319-z
Goodchild, M., Nargis, N., & D’Espaignet, E. T. (2018). Global economic cost of smoking-attributable diseases. Tobacco Control, 27(1), 58–64. https://doi.org/10.1136/tobaccocontrol-2016-053305
Higgins, J., & Green, S. (2009). Cochrane Handbook for Systematic Reviews of Interventions. In The Cochrane Collaboration (Vol. 5). https://doi.org/10.1002/9780470712184
Hilts, K. E., Elkhadragy, N., Corelli, R. L., Hata, M., Tong, E. K., Vitale, F. M., & Hudmon, K. S. (2024). Closing the Tobacco Treatment Gap: A Qualitative Study of Tobacco Cessation Service Implementation in Community Pharmacies. Pharmacy, 12(2), 59. https://doi.org/10.3390/pharmacy12020059
Husereau, D., Drummond, M., Augustovski, F., de Bekker-Grob, E., Briggs, A. H., Carswell, C., Caulley, L., Chaiyakunapruk, N., Greenberg, D., Loder, E., Mauskopf, J., Mullins, C. D., Petrou, S., Pwu, R. F., & Staniszewska, S. (2022). Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMC Medicine, 20(1), 23. https://doi.org/10.1186/s12916-021-02204-0
Ibrahim, M. I. M., Magzoub, N. A. M., & Maarup, N. (2016). University-based smoking cessation program through pharmacist-physician initiative: An economic evaluation. Journal of Clinical and Diagnostic Research, 10(2), LC11–LC15. https://doi.org/10.7860/JCDR/2016/17641.7325
International Pharmaceutical Federation. (2024). Pharmacist-led tobacco cessation services Evidence Of Impact & Country Highlights. International Pharmaceutical Federation. www.fip.org
Leung, L. (2016). Health Economic Evaluation: A Primer for Healthcare Professionals. Primary Health Care Open Access, 6(2). https://doi.org/10.4172/2167-1079.1000223
Martínez, J. C. G., Gaztelurrutia Lavesa, L., Mendoza Barbero, A., Plaza Zamora, J., Lage Piñón, M., Aguiló Juanola, M., Climent Catalá, M., de Andrés Dirube, A., García Moreno, L., Jaraiz Magariños, I., Moral Ajado, M., & Sánchez Marcos, N. (2024). Smoking cessation intervention in the community pharmacy: Cost-effectiveness of a non-randomized cluster-controlled trial at 12-months’ follow-up. Research in Social and Administrative Pharmacy, 20(1), 19–27. https://doi.org/10.1016/j.sapharm.2023.09.003
Mohseni, M., Ameri, H., & Arab-Zozani, M. (2022). Potential limitations in systematic review studies assessing the effect of the main intervention for treatment/therapy of COVID-19 patients: An overview. In Frontiers in Medicine (Vol. 9). Frontiers Media S.A. https://doi.org/10.3389/fmed.2022.966632
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. In PLoS Medicine (Vol. 18, Issue 3). Public Library of Science. https://doi.org/10.1371/JOURNAL.PMED.1003583
Phillips, L. C. E., Nguyen, H., Genge, T. L., & Maddigan, W. J. (2022). Effectiveness and cost-effectiveness of an intensive and abbreviated individualized smoking cessation program delivered by pharmacists: A pragmatic, mixed-method, randomized trial. Canadian Pharmacists Journal, 155(6), 334–344. https://doi.org/10.1177/17151635221128263
Phimarn, W., Saramunee, K., Leelathanalerk, A., Srimongkon, P., Chanasopon, S., Phumart, P., Paktipat, P., & Babar, Z. U. D. (2023). Economic evaluation of pharmacy services: a systematic review of the literature (2016–2020). In International Journal of Clinical Pharmacy (Vol. 45, Issue 6, pp. 1326–1348). Springer Science and Business Media Deutschland GmbH. https://doi.org/10.1007/s11096-023-01590-0
Qin, T., Jin, Q., Li, X., Bai, X., Qiao, K., Gu, M., & Wang, Y. (2022). A Cost-Effectiveness Analysis of Comprehensive Smoking-Cessation Interventions Based on the Community and Hospital Collaboration. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.853438
Rabarison, K. M., Bish, C. L., Massoudi, M. S., & Giles, W. H. (2015). Economic evaluation enhances public health decision making. Frontiers in Public Health, 3(JUN). https://doi.org/10.3389/fpubh.2015.00164
Reisinger, S. A., Kamel, S., Seiber, E., Klein, E. G., Paskett, E. D., & Wewers, M. E. (2019). Cost-effectiveness of community-based tobacco dependence treatment interventions: Initial findings of a systematic review. Preventing Chronic Disease, 16(12). https://doi.org/10.5888/pcd16.190232
Saba, M., Diep, J., Saini, B., & Dhippayom, T. (2014). Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy. Journal of Clinical Pharmacy and Therapeutics, 39, 240–247. https://doi.org/10.1111/jcpt.12131
Sideri, S., Papageorgiou, S. N., & Eliades, T. (2018). Registration in the international prospective register of systematic reviews (PROSPERO) of systematic review protocols was associated with increased review quality. In Journal of Clinical Epidemiology (Vol. 100, pp. 103–110). Elsevier USA. https://doi.org/10.1016/j.jclinepi.2018.01.003
World Health Organization. (2025). Tobacco
