Cost of a smoking cessation program/intervention: Consider a hypothetical smoking cessation program implemented in a health clinic. The cessation program primarily uses counseling and nicotine replacement to aid patients who express a desire to quit smoking. A program director is the full-time administrator of the program and patient services are provided by two registered nurse patient navigators within the clinic, who serve all patients seen at the clinic. Each patient navigator is 1.0 FTE for the entire clinic. There are a total of 200 patients seen in the clinic per month and of those patients, 50 are enrolled in the smoking cessation program. The program directors salary is $79,000 per year and each patient navigators salary is $55,000 per year. The services offered by the program are free to patients and the clinic is reimbursed for the services through the state Medicaid program. Nicotine replacement costs $152 per patient per month. The clinic is reimbursed at a monthly rate of $175 per patient enrolled in the cessation program. The patients are referred from primary health care providers within the health care system of which the clinic is a part, and are seen on a bi-weekly basis to receive medication and counseling. The program is implemented January 2015 March 2015. Patients receive follow-up contact in the subsequent 3 and 6 months (June and September) after the end of implementation of the program. Follow-up is provided via phone contact only by the program director to assess continued progress of the patient and document any problems or concerns to report back to the health care system. Prior to program implementation, the program director developed the protocol for the program, trained patient navigators, and marketed the materials to primary health care providers within the health system. This was the program directors full time responsibilities fromJanuary December 2014. The costs for protocol development were $18,000, costs for training patient navigators were $48,750, and costs for marketing were $12,250 in addition to program directors salary. You are interested in designing a study to estimate the cost of the smoking cessation program.

Questions:

(1) Determine the perspective for analysis. Table 1 shows an example of four perspectives that could be considered in this case study: patients perspective, the providers perspective, the health sector perspective, and the societal perspective.

(2) Determine the intervention timeframe & analytic horizon.

(3) Evaluate Program costs. a. Determine the costs to be included, based on the perspective youve chosen?

b. Categorize each cost (i.e. Is it pre-implementation, implementation or post- implementation?)

c. Identify analytic horizon for each cost, the cost, % FTE by line item. d. Total costs by line item. e. Calculate total intervention costs for program.

Yes Yes No Yes Table 1. Example of costs that need to be included or excluded as a function of the perspective chosen to conduct an economic analysis Analysis perspective Example of cost Patient Provider Health Sector Society Direct medical Yes/ (if Physician time Yes applies) Other medical personnel time No Yes Yes Yes Yes (if Medications No Yes Yes applies) Medical devices No Yes Laboratory tests No No Yes Yes Direct non-medical Administration No Yes/No Yes Yes Physical facility (eg, clinic) Yes Yes Utilities No No Yes Yes Patient's travel costs Yes No No Yes Education Training Yes/No Indirect costs Time off work for office visits Yes No No Yes Time off work from illness No Yes Notes: The table was adapted from Meltzer 2001 Yes means that the specific cost cost item should be included in the corresponding perspective, No means the cost should not be included. The perspectives were chosen for illustrative purposes, the do not cover all possible perspectives. The inclusion of the costs items listed depend upon the specific perspective chosen Assumes that patient has some type of health-insurance. The specific inclusion exclusion of cost items depends upon the characteristics of the insurance. Physician time and medication costs in this example include co-payments. The provider perspective in this example is the health clinic staff providing services. Health sector perspective includes all providers and payers and assumes that all medical costs are paid by the health sector *The societal perspective includes all costs and benefits irrespective of who pays, it is the most comprehensive perspective and can be thought of as the sum of all perspectives minus transfers. Transfers are not included because they are only a way of distributing resources within a society, they do not increase or decrease the overall costs or benefits that a society perceives. Physician practice and health insurer may have separate administration costs. No No No Yes Yes Yes No Yes Yes No Yes Table 1. Example of costs that need to be included or excluded as a function of the perspective chosen to conduct an economic analysis Analysis perspective Example of cost Patient Provider Health Sector Society Direct medical Yes/ (if Physician time Yes applies) Other medical personnel time No Yes Yes Yes Yes (if Medications No Yes Yes applies) Medical devices No Yes Laboratory tests No No Yes Yes Direct non-medical Administration No Yes/No Yes Yes Physical facility (eg, clinic) Yes Yes Utilities No No Yes Yes Patient's travel costs Yes No No Yes Education Training Yes/No Indirect costs Time off work for office visits Yes No No Yes Time off work from illness No Yes Notes: The table was adapted from Meltzer 2001 Yes means that the specific cost cost item should be included in the corresponding perspective, No means the cost should not be included. The perspectives were chosen for illustrative purposes, the do not cover all possible perspectives. The inclusion of the costs items listed depend upon the specific perspective chosen Assumes that patient has some type of health-insurance. The specific inclusion exclusion of cost items depends upon the characteristics of the insurance. Physician time and medication costs in this example include co-payments. The provider perspective in this example is the health clinic staff providing services. Health sector perspective includes all providers and payers and assumes that all medical costs are paid by the health sector *The societal perspective includes all costs and benefits irrespective of who pays, it is the most comprehensive perspective and can be thought of as the sum of all perspectives minus transfers. Transfers are not included because they are only a way of distributing resources within a society, they do not increase or decrease the overall costs or benefits that a society perceives. Physician practice and health insurer may have separate administration costs. No No No Yes Yes Yes No