• C A Jiménez-Ruiz, V Martín, X Alsina-Restoy, J I de Granda-Orive, E de Higes-Martínez, M García-Rueda, M Genovés-Crespo, C López-García, J J Lorza-Blasco, F L Márquez, Á Ramos-Pinedo, J A Riesco-Miranda, J Signes-Costa, S Solano-Reina, P Vaquero-Lozano, and J Rejas.
• Specialized Tobacco Unit, Hospital Clínico San Carlos, Madrid, Spain.
• Br J Surg. 2020 Jul 1; 107 (8): 978-994.

BackgroundSmoking at the time of surgery is associated with postoperative complications. Quitting smoking before surgery is linked to fewer complications during the hospital stay. This work analysed whether a smoking cessation intervention before surgery is economically worthwhile when funded by the National Health System (NHS) in Spain.MethodsThe economic analysis considered costs and benefits of the intervention to the NHS for the year 2016. The population who would benefit comprised adult smokers who were ready to quit and for whom surgery requiring admission to hospital was planned. The intervention, a combination of medical counselling and use of a smoking cessation drug which should occur 12 weeks before surgery, considered one attempt only to quit smoking. Benefits were costs avoided by averting postoperative complications if cessation was successful. The analysis compared the net economic outcome (benefit minus cost of intervention) and the return on investment, for intervention funded by the NHS versus the current situation without funding.ResultsSmoking cessation increased by 21·7 per cent with funding; the rate was 32·5 per cent when funded versus 10·7 per cent without funding, producing 9611 extra quitters. The cost per averted smoker was €1753 with a benefit of €503, achieving a net economic benefit of €4·8 million per year. Given the annual cost of the intervention (€17·4 million, of which €5·6 million (32·5 per cent) represents drugs), the return on investment was 28·7 per cent annually, equivalent to €1·29 per €1 of investment.ConclusionFrom the perspective of the Spanish NHS, the benefit of funding smoking cessation before surgery, in terms of healthcare cost savings, appears to greatly outweigh the costs.© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.

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