Purpose: Cigarette smoking during the perioperative period increases the risk of postoperative mortality, cardiac, pulmonary, wound, and infectious complications. Preoperative smoking abstinence has been associated with beneficial reductions in risk of these complications. Physician intervention is sometimes supplemented with formalized smoking cessation programs, which have a cost to the hospital and third-party payer. In this study we sought to analyze the cost-benefit of formalized smoking cessation programs on in hospital postoperative complications from the third-party payer perspective. We hypothesized that preoperative smoking cessation will be cost-effective compared to those who do not undergo a smoking cessation program.
Methods: Using a compilation of data sources, a cost-benefit decision analysis was designed to assess the cost-effectiveness of preoperative smoking cessation programs. The outcomes of interest were infectious, cardiovascular, thromboembolic, and respiratory complications. Sensitivity analyses were conducted to assess the variables with the greatest uncertainty.
Results: Given a willingness-to-pay of $50,000/QALY, we determined an ICER of $37,433/QALY, which is cost-effective. The variables with the greatest uncertainty were the utilities for no and one complication, as well as, the probabilities for respiratory and infectious complications in both current and former smokers. However, when conducting Monte-Carlo Incremental Cost-Effectiveness Simulations demonstrated that under most conditions the model is cost-effective for a willingness-to-pay of $50,000/QALY.
Conclusions: Preoperative tobacco cessation programs are cost-effective with a willingness-to-pay of $50,000 compared to no formal intervention when considering a time-horizon of the hospital stay. Out results are limited due to the unknown effects of smoking cessation within 8 weeks of surgery. Figure: Monte-Carlo Simulation of the Incremental Cost-effectiveness with a willingness-to-pay of $50,000 
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