Washington State Institute for Public Policy
More intensive tobacco quitlines (compared to less intensive quitlines)
Public Health & Prevention: Population-level policies
Benefit-cost estimates updated May 2017.  Literature review updated December 2014.
Quitlines offer telephone counseling, frequently with nicotine replacement, to assist clients to quit smoking. The effect of offering multiple calls was compared with the effect of providing a single call to the quitline.
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 $1,577 Benefits minus costs $9,556
Participants $3,186 Benefit to cost ratio $73.51
Others $189 Chance the program will produce
Indirect $4,736 benefits greater than the costs 100 %
Total benefits $9,687
Net program cost ($132)
Benefits minus cost $9,556
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 $1,425 $3,137 $0 $4,725 $9,286
Health care associated with smoking $152 $50 $189 $77 $467
Adjustment for deadweight cost of program $0 $0 $0 ($66) ($66)
Totals $1,577 $3,186 $189 $4,736 $9,687
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $214 2014 Present value of net program costs (in 2016 dollars) ($132)
Comparison costs $84 2014 Cost range (+ or -) 10 %
Medicaid (and many private health insurance programs) funds quitlines at up-to-five calls and nicotine replacement therapy (NRT) to about a quarter of callers. The reimbursement is $205 per person. (Email from Tonya Nichols at WA Health Care Authority and fee schedule for physician related services, code S9453). Comparison is the cost WA Department of Health pays for a single call for uninsured residents of Washington, including NRT to about a quarter of all callers (Email from Joella Pyatt, Oct 18, 2014).
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 13 15098 -0.133 0.023 41 -0.133 0.023 42 -0.253 0.001
Citations Used in the Meta-Analysis

Borland, R., Segan, C.J., Livingston, P.M., & Owen, N. (2001). The effectiveness of callback counselling for smoking cessation: a randomized trial. Addiction, 96(6), 881-9.

Borland, R., Balmford, J., Segan, C., Livingston, P., & Owen, N. (2003). The effectiveness of personalized smoking cessation strategies for callers to a Quitline service. Addiction, 98(6), 837-846.

Gilbert, H., & Sutton, S. (2006). Evaluating the effectiveness of proactive telephone counselling for smoking cessation in a randomized controlled trial. Addiction, 101,(4), 590-598.

Hollis, J.F., McAfee, T.A., Fellows, J.L., Zbikowski, S.M., & Stark, M. (2007). The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. BMJ Group.

Rabius, V., McAlister, A.L., Geiger, A., Huang, P., & Todd, R. (2004). Telephone counseling increases cessation rates among young adult smokers. Health Psychology, 23(5), 539-41.

Rabius, V., Pike, K.J., Hunter, J., Wiatrek, D., & McAlister, A.L. (2007). Effects of frequency and duration in telephone counselling for smoking cessation. BMJ Group.

Sims, T.H., McAfee, T., Fraser, D.L., Baker, T.B., Fiore, M.C., & Smith, S.S. (2013). Quitline cessation counseling for young adult smokers: a randomized clinical trial. Nicotine & Tobacco Research, 15(5), 932-41.

Smith, P.M., Cameron, R., McDonald, P.W., Kawash, B., Madill, C., & Brown, K.S. (2004). Telephone counseling for population-based smoking cessation. American Journal of Health Behavior, 28(3), 231-241.

Zhu, S.H., Stretch, V., Balabanis M., Rosbrook, B., Sadler, G., & Pierce, J.P. (1996). Telephone counseling for smoking cessation: Effects of single-session and multiple-session interventions. Journal of Consulting and Clinical Psychology, 64(1), 202-211.

Zhu, S.H., Cummins, S.E., Wong, S., Gamst, A.C., Tedeschi, G.J., & Reyes-Nocon, J. (2012). The effects of a multilingual telephone quitline for Asian smokers: a randomized controlled trial. Journal of the National Cancer Institute, 104,(4), 299-310.

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