Cost-effectiveness of smoking cessation modalities: comparing apples with oranges?

BACKGROUND Although the results of self-help and group treatments for smoking cessation are known, the cost effectiveness and participants' characteristics of these treatments remain mostly undetermined. METHODS Consecutive samples of 84 self-help manual requesters and 83 group participants in a Dutch community-based smoking cessation program were subjected to telephone interviews before treatment and after a 6-month follow-up. Participants' baseline characteristics were compared and contrasted with a random sample of nonparticipating smokers (N = 924). Cost effectiveness rates were computed from the perspectives of the society, the steering group, and the participants. RESULTS Participants appeared to be more "hardcore smokers" than nonparticipants. Self-help manual requesters seemed easier quitters than group participants. Self-help was at least three times as cost effective as group treatment from the perspective of the program provider and over four times as cost effective from the viewpoint of the participants. When taking savings through not smoking into account, return on the social investment was positive. CONCLUSIONS From a social perspective, the project seemed cost effective, compared with medical interventions. Since both modalities attracted different groups of smokers, cost effectiveness comparisons may incorporate the comparison of apples with oranges, and referral to either modality should be based on smokers' characteristics and the societal value placed on health as well.