Washington State Institute for Public Policy
Text messaging programs for smoking cessation
Public Health & Prevention: Community-based
Benefit-cost estimates updated May 2017.  Literature review updated December 2014.
Text message-based smoking cessation interventions use short message service (SMS) to support smokers in quit attempts. Generally, the programs help participants set a quit date, send motivational text messages, and send supportive messages after the quit date. Many of the interventions feature interactive components such as a craving helpline to receive instant support or check-ins to assess the participant’s stage of change.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $3,798 Benefits minus costs $19,149
Participants $7,785 Benefit to cost ratio $363.46
Others $382 Chance the program will produce
Indirect $7,238 benefits greater than the costs 100 %
Total benefits $19,202
Net program cost ($53)
Benefits minus cost $19,149
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Labor market earnings associated with smoking $3,490 $7,685 $0 $7,110 $18,285
Health care associated with smoking $308 $100 $382 $154 $944
Adjustment for deadweight cost of program $0 $0 $0 ($26) ($26)
Totals $3,798 $7,785 $382 $7,238 $19,202
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $52 2014 Present value of net program costs (in 2016 dollars) ($53)
Comparison costs $0 2014 Cost range (+ or -) 10 %
Mid-point per-participant cost estimates came from two articles: Guerriero, (2013). The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop. The European Journal of Health Economics, 14(5), 789-797; and Wells et al. (2012). Cost-effectiveness analysis of a mobile phone SMS text-based smoking cessation intervention. University of Toronto Medical Journal, 89(3), 160-165.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Regular smoking 9 4931 -0.243 0.078 33 -0.243 0.078 43 -0.285 0.001
Citations Used in the Meta-Analysis

Abroms, L.C., Boal, A.L., Simmens, S.J., Mendel, J.A., & Windsor, R.A. (2014). A randomized trial of Text2Quit: A text messaging program for smoking cessation. American Journal of Preventive Medicine, 47(3), 242-50.

Brendryen, H., Drozd, F., & Kraft, P. (2008). A digital smoking cessation program delivered through internet and cell phone without nicotine replacement (happy ending): Randomized controlled trial. Journal of Medical Internet Research, 10(5), e51.

Free, C., Whittaker, R., Knight, R., Abramsky, T., Rodgers, A., & Roberts, I.G. (2009). Txt2stop: a pilot randomised controlled trial of mobile phone-based smoking cessation support. Tobacco Control, 18 (2), 88-91.

Free, C., Knight, R., Robertson, S., Whittaker, R., Edwards, P., Zhou, W., Rodgers, A., Cairns, J., Kenward, M.G., & Roberts, I. (2011). Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet, 378 (9785), 49-55.

Haug, S., Meyer, C., Schorr, G., Bauer, S., & John, U. (2009). Continuous individual support of smoking cessation using text messaging: a pilot experimental study. Nicotine & Tobacco Research, 11 (8), 915-23.

Haug, S., Schaub, M.P., Venzin, V., Meyer, C., & John, U. (2013). Efficacy of a text message-based smoking cessation intervention for young people: a cluster randomized controlled trial. Journal of Medical Internet Research, 14 (809), 1-8.

Naughton, F., Prevost, A.T., Gilbert, H., & Sutton, S. (2012). Randomized controlled trial evaluation of a tailored leaflet and SMS text message self-help intervention for pregnant smokers (MiQuit). Nicotine & Tobacco Research, 14 (5), 569-577.

Rodgers, A., Corbett, T., Bramley, D., Riddell, T., Wills, M., Lin, R.B., & Jones, M. (2005). Do u smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text messaging. Tobacco Control, 14 (4), 255-261.

Ybarra, M., Korchmaros, J., Bosi, A.T.B., & Emri, S. (2012). A text messaging-based smoking cessation program for adult smokers: Randomized controlled trial. Journal of Medical Internet Research, 14 (6), e172.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov