JAMA Netw Open. 2026 Mar 2;9(3):e261543. doi: 10.1001/jamanetworkopen.2026.1543.
ABSTRACT
IMPORTANCE: Evidence of cost-effectiveness is needed to demonstrate the value of smoking cessation behavioral interventions.
OBJECTIVE: To evaluate the cost-effectiveness of motivation and problem-solving (MAPS) against standard treatment (ST) for smoking cessation among patients with a history of cervical intraepithelial neoplasia or cervical cancer.
DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation, a cost-effectiveness analysis was conducted from the perspective of cancer centers using data collected in a randomized clinical trial conducted between February 2017 and January 2020 with follow-up until August 2021 that compared MAPS with ST. MAPS is a behavioral intervention that emphasizes smoking cessation and relapse prevention while addressing life events, stressors, and other individual concerns. The trial included up to 6 counseling sessions of MAPS delivered over 12 months. Data were analyzed from January 2024 to December 2025.
EXPOSURE: Inclusion in a smoking cessation randomized clinical trial that compared MAPS with ST.
MAIN OUTCOMES AND MEASURES: Deterministic and probabilistic cost-effectiveness analyses were conducted and findings were reported as incremental cost-effectiveness ratio and cost-effectiveness acceptability curve, respectively, for 7-day point prevalence abstinence at months 12 and 18.
RESULTS: The analysis included 194 participants. Study participants had a mean (SD) age of 47.8 (10.8) years, had a mean (SD) smoking history of 29.1 (12.1) years, and smoked a mean (SD) of 15.5 (8.7) cigarettes per day. Mean costs were $522.74 (95% CI, $500.19 to $545.29) and $389.26 (95% CI, $362.67 to $415.84) per participant for MAPS (98 participants) and ST (96 participants), respectively. At month 12, abstinence rates were 26.5% and 12.5% for MAPS and ST, respectively. The deterministic analysis found that the incremental cost for MAPS vs ST was $921 per quit at month 12 and $7458 per quit at month 18. The probabilistic analysis found that at the societal willingness to pay of $10 000 per quit, the probability that MAPS is cost-effective at month 12 was nearly 100% but reduced to 52% at month 18. Subgroup analysis found a lower incremental cost-effectiveness ratio when comparing the high MAPS engagement subgroup with the ST group. The cost-effectiveness of MAPS (vs ST) was sustained at month 18 among the high MAPS engagement subgroup despite a decline in 7-day abstinence.
CONCLUSIONS AND RELEVANCE: In this cost-effectiveness analysis, there was robust evidence supporting the cost-effectiveness of MAPS (vs ST) at month 12 and moderate evidence at month 18 in terms of incremental cost per quit. The attenuation of intervention outcome over time was more pronounced among participants with less than 4 sessions of MAPS.
PMID:41817524 | DOI:10.1001/jamanetworkopen.2026.1543
