***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The aim of this study was to evaluate and compare the cost-effectiveness of varenicline with nicotine replacement therapy ( NRT ) for smoking cessation in four European countries ( Belgium , France , Sweden and the UK ) . METHODS Markov simulations , using the Benefits of Smoking Cessation on Outcomes ( BENESCO ) model , were performed . We simulated the incidence of four smoking-related morbidities : lung cancer , chronic obstructive pulmonary disease , coronary heart disease and stroke . The model computes quality -adjusted life-years gained and incremental cost-effectiveness ratios . Incremental cost-utility ratios were calculated , adopting a lifetime perspective . Efficacy data were obtained from a r and omized open-label trial : Week 52 continuous abstinence rates were 26.1 % for varenicline and 20.3 % for NRT . RESULTS The analyses imply that for countries analysed , smoking cessation using varenicline versus NRT was associated with reduced smoking-related morbidity and mortality . The number of morbidities avoided , per 1000 smokers attempting to quit , ranged from 9.7 in Belgium to 6.5 in the UK . The number of quality -adjusted life-years gained , per 1000 smokers , was 23 ( Belgium ) ; 19.5 ( France ) ; 29.9 ( Sweden ) ; and 23.7 ( UK ) . In all base-case simulations ( except France ) , varenicline dominated ( more effective and cost saving ) NRT regarding costs per quality -adjusted life-year gained ; for France the incremental cost-effectiveness ratio was 2803 . CONCLUSION This cost-effectiveness analysis demonstrated that since varenicline treatment was more effective , the result was increased healthcare cost savings in Belgium , Sweden and the UK . Our results suggest that funding varenicline as a smoking cessation aid is justifiable from a healthcare re source allocation perspective Introduction : School-based smoking prevention programmes can be effective , but evidence on cost-effectiveness is lacking . We conducted a cost-effectiveness analysis of a school-based “ peer-led ” intervention . Methods : We evaluated the ASSIST ( A Stop Smoking In Schools Trial ) programme in a cluster r and omized controlled trial . The ASSIST programme trained students to act as peer supporters during informal interactions to encourage their peers not to smoke . Fifty-nine secondary schools in Engl and and Wales were r and omized to receive the ASSIST programme or usual smoking education . Ten thous and seven hundred and thirty students aged 12–13 years attended participating schools . Previous work has demonstrated that the ASSIST programme achieved a 2.1 % ( 95 % CI = 0%–4.2 % ) reduction in smoking prevalence . We evaluated the public sector cost , prevalence of weekly smoking , and cost per additional student not smoking at 24 months . Results : The ASSIST programme cost of £ 32 ( 95 % CI = £ 29.70–£33.80 ) per student . The incremental cost per student not smoking at 2 years was £ 1,500 ( 95 % CI = £ 669–£9,947 ) . Students in intervention schools were less likely to believe that they would be a smoker at age 16 years ( odds ratio [ OR ] = 0.80 ; 95 % CI = 0.66–0.96 ) . Conclusions : A peer-led intervention reduced smoking among adolescents at a modest cost . The intervention is cost-effective under realistic assumptions regarding the extent to which reductions in adolescent smoking lead to lower smoking prevalence and /or earlier smoking cessation in adulthood . The annual cost of extending the intervention to Year 8 students in all U.K. schools would be in the region of £ 38 million and could result in 20,400 fewer adolescent smokers OBJECTIVES To : evaluate the impact of smoking status on objective productivity and absenteeism measures ; evaluate the impact of smoking status on subjective measures of productivity ; and assess the correlation between subjective and objective productivity measures . DESIGN Prospect i ve cohort study in a workplace environment . SUBJECTS Approximately 300 employees ( 100 each of former , current , and never smokers ) at a reservation office of a large US airline . MAIN OUTCOME MEASURES Objective productivity and absenteeism data were supplied by the employer . Subjective assessment s of productivity were collected using a self report instrument , the Health and Work Question naire ( HWQ ) . RESULTS Current smokers had significantly greater absenteeism than did never smokers , with former smokers having intermediate values ; among former smokers , absenteeism showed a significant decline with years following cessation . Former smokers showed an increase in seven of 10 objective productivity measures as compared to current smokers , with a mean increase of 4.5 % . While objective productivity measures for former smokers decreased compared to measures for current smokers during the first year following cessation , values for former smokers were greater than those for current smokers by 1–4 years following cessation . Subjective assessment s of “ productivity evaluation by others ” and “ personal life satisfaction ” showed significant trends with highest values for never smokers , lowest for current smokers , and intermediate for former smokers . CONCLUSIONS Workplace productivity is increased and absenteeism is decreased among former smokers as compared to current smokers . Productivity among former smokers increases over time toward values seen among never smokers . Subjective measures of productivity provide indications of novel ways of productivity assessment that are sensitive to smoking status Background Although effective smoking cessation interventions exist , information is limited about their cost-effectiveness and cost-utility . Objective To assess the cost-effectiveness and cost-utility of an Internet-based multiple computer-tailored smoking cessation program and tailored counseling by practice nurses working in Dutch general practice s compared with an Internet-based multiple computer-tailored program only and care as usual . Methods The economic evaluation was embedded in a r and omized controlled trial , for which 91 practice nurses recruited 414 eligible smokers . Smokers were r and omized to receive multiple tailoring and counseling ( n=163 ) , multiple tailoring only ( n=132 ) , or usual care ( n=119 ) . Self-reported cost and quality of life were assessed during a 12-month follow-up period . Prolonged abstinence and 24-hour and 7-day point prevalence abstinence were assessed at 12-month follow-up . The trial-based economic evaluation was conducted from a societal perspective . Uncertainty was accounted for by bootstrapping ( 1000 times ) and sensitivity analyses . Results No significant differences were found between the intervention arms with regard to baseline characteristics or effects on abstinence , quality of life , and addiction level . However , participants in the multiple tailoring and counseling group reported significantly more annual health care – related costs than participants in the usual care group . Cost-effectiveness analysis , using prolonged abstinence as the outcome measure , showed that the mere multiple computer-tailored program had the highest probability of being cost-effective . Compared with usual care , in this group € 5100 had to be paid for each additional abstinent participant . With regard to cost-utility analyses , using quality of life as the outcome measure , usual care was probably most efficient . Conclusions To our knowledge , this was the first study to determine the cost-effectiveness and cost-utility of an Internet-based smoking cessation program with and without counseling by a practice nurse . Although the Internet-based multiple computer-tailored program seemed to be the most cost-effective treatment , the cost-utility was probably highest for care as usual . However , to ease the interpretation of cost-effectiveness results , future research should aim at identifying an acceptable cutoff point for the willingness to pay per abstinent participant PURPOSE To evaluate the incremental effectiveness and cost-effectiveness of a staged-based , computerized smoking cessation intervention relative to st and ard care in an urban managed care network of primary care physicians . DESIGN Decision-analytic model based on results of a r and omized clinical trial . METHODOLOGY Patient outcomes and cost estimates were derived from clinical trial data . Effectiveness was measured in terms of 7-day point-prevalence abstinence at 6 months post-intervention . Quality -adjusted life years ( QALYs ) and cost-effectiveness ( CE ) were calculated , with CE measured as cost per patient per life year saved and per quality -adjusted life years saved . CE estimates were adjusted to account for partial behavior change as measured in terms of progression in stage of readiness to quit . Sensitivity analyses were conducted to evaluate the robustness of key model assumptions . PRINCIPAL FINDINGS Intervention patients were 1.77 times more likely to be smoke-free at 6 months follow-up than those in st and ard care ( p=.078 ) . The intervention generated an additional 3.24 quitters per year . Annualized incremental costs were $ 5,570 per primary care practice , and $ 40.83 per smoker . The mean incremental cost-effectiveness ratio was $ 1,174 per life year saved ( $ 869 per QALY ) . When the intervention impact on progression in stage of readiness to quit was also considered , the mean incremental cost-effectiveness ratio declined to $ 999 per life year saved ( $ 739 per QALY ) . CONCLUSIONS From a physician 's practice perspective , the stage-based computer tailored intervention was cost-effective relative to st and ard care . Incorporation of partial behavior change into the model further enhanced favorability of the cost-effectiveness ratio Introduction : An employer-based cost-benefit analysis for varenicline versus bupropion was conducted using clinical outcomes from a recently published trial . Methods : A decision tree model was developed based on the net benefit of treatment to produce a nonsmoker at 1 year . Sensitivity analyses were conducted based on quit rates with placebo and varenicline and the cost of varenicline . Results : Estimated 12-month employer cost savings per non-smoking employee were $ 540.60 for varenicline , $ 269.80 for bupropion SR generic , $ 150.80 for bupropion SR br and , and $ 81.80 for placebo . Varenicline was more cost beneficial  than placebo , which had quit rates of 16.9 % or less . The quit rate  with varenicline would have to be ≤16.9 % to lose cost benefit over bupropion SR generic . Conclusions : The economic benefit  of varenicline is improved over bupropion , despite the increased initial cost of varenicline There is a lack of evidence of the relative cost-effectiveness of proactive telephone counseling ( PTC ) and Web-based delivery of smoking cessation services in conjunction with pharmacotherapy . We calculated the differential cost-effectiveness of three behavioral smoking cessation modalities with varenicline treatment in a r and omized trial of current smokers from a large health system . Eligible participants were r and omized to one of three smoking cessation interventions : Web-based counseling ( n = 401 ) , PTC ( n = 402 ) , or combined PTC-Web counseling ( n = 399 ) . All participants received a st and ard 12-week course of varenicline . The primary outcome was a 7-day point prevalent nonsmoking at the 6 month follow-up . The Web intervention was the least expensive followed by the PTC and PTC-Web groups . Costs per additional 6-month nonsmoker and per additional lifetime quitter were $ 1,278 and $ 2,601 for Web , $ 1,472 and $ 2,995 for PTC , and $ 1,617 and $ 3,291 for PTC-Web . Cost per life-year ( LY ) and quality -adjusted life-year ( QALY ) saved were $ 1,148 and $ 1,136 for Web , $ 1,320 and $ 1,308 for PTC , and $ 1,450 and $ 1,437 for PTC-Web . Based on the cost per LY and QALY saved , these interventions are among the most cost-effective life-saving medical treatments . Web , PTC , and combined PTC-Web treatments were all highly cost-effective , with the Web treatment being marginally more cost-effective than the PTC or combined PTC-Web treatments BACKGROUND Employers have responded to new regulations on the effects of passive smoking by introducing a range of workplace policies . Few policies include provision of smoking cessation intervention . OBJECTIVE To estimate the cost to employers of smoking in the workplace in Scotl and to illustrate the potential gains from smoking cessation provision . Costs vary with type of smoking policy in place ; therefore , to estimate these costs results from a survey were combined with evidence drawn from a literature review . STUDY DESIGN A telephone survey of 200 Scottish workplaces , based on a stratified r and om sample of workplaces with 50 or more employees , was conducted in 1996 . Additional evidence was compiled from a review of the literature of smoking related costs and specific smoking related effects . RESULTS 167 completed responses were received , of which 156 employers ( 93 % ) operated a smoking policy , 57 ( 34 % ) operated smoke free buildings , and 89 ( 53 % ) restricted smoking to a “ smoke room ” . The research literature shows absenteeism to be higher among smokers when compared to non-smokers . The estimated cost of smoking related absence in Scotl and is £ 40 million per annum . Total productivity losses are estimated at approximately £ 450 million per annum . In addition , the re source cost in terms of losses from fires caused by smoking material s is estimated at approximately £ 4 million per annum . In addition , there are costs from sm 
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Smoking also yields cost savings in pension payments from the premature death of smokers .
3 .
The use of pharmacotherapies such as varenicline , NRT , and Bupropion , when combined with GP counseling or other behavioral treatment interventions ( such as proactive telephone counseling and Web-based delivery ) , is both clinical ly effective and cost effective to primary health care providers .
5 .
Price-based policy measures such as increase in tobacco taxes  are unarguably the most effective means of reducing the consumption of tobacco .
6 .
Smoking cessation classes are known to be most effective among community-based measures , as they could lead to a quit rate of up to 35 % , but they usually incur higher costs than other measures such as self-help quit-smoking kits .
7 .
Advertising media , telecommunications , and other technology-based interventions ( such as TV , radio , print , telephone , the Internet , PC , and other electronic media ) usually have positive synergistic effects in reducing smoking prevalence especially when combined to deliver smoking cessation messages and counseling support .
9 .
Implementing smoke-free workplaces would also produce myriads of new quitters and reduce the amount of cigarette consumption , leading to cost savings in direct medical costs to primary health care providers .
Workplace interventions are , however , likely to yield far greater economic benefits over the long term , as reduced prevalence will lead to a healthier and more productive workforce .
Conclusions We conclude that the direct costs and externalities to society of smoking far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes ( ie , in terms of a healthy population and a productive workforce ) .
However , on the balance of probabilities , most of the cessation measures review ed have not only proved effective but also cost effective in delivering the much desired cost savings and net gains to individuals and primary health care providers