Cost-effectiveness of a preoperative 12-week smoking cessation program prior to arthroscopic rotator cuff repair

Background: This study aims to evaluate the cost utility of preoperative 12-week smoking cessation program (SCP) in adults undergoing arthroscopic rotator cuff repair. Methods: A decision-analysis model was developed for a hypothetical adult smoker undergoing arthroscopic rotator cuff repair. Literature review data identified event probabilities, costs, and health utilities. Health outcomes were measured in Quality-Adjusted Life Years (QALYs). Base-case analysis calculated incremental cost and effectiveness of a 12-week preoperative SCP. Probabilistic sensitivity analysis evaluated model uncertainty and calculated mean incremental costs, effectiveness, and net monetary benefits. One-way sensitivity analysis identified variables with the greatest model impact. Results: The preoperative 12-week SCP was the preferred strategy in 98.4% of iterations. It demonstrated greater benefits and lower costs, with an incremental cost-effectiveness ratio below the willingness-to-pay threshold of $50,000 per QALY. The use of preoperative 12-week SCP was associated with a mean incremental net monetary benefit of $16,338 (95% confidence interval: 15,889-16,787). One-way sensitivity analyses identified QALYs associated with avoiding revision surgery due to retear as a key driver of the cost-utility outcomes. Conclusion: Use of a preoperative 12-week SCP is a cost-effective approach to reduce costs related to revision surgery and providing higher QALYs at 5 years. The use of SCPs should be strongly considered as part of patient management strategies.