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Smoking Cessation and Quality of Life: Insights From Analysis of Longitudinal Australian Data, an Application for Economic Evaluations

Published:March 17, 2021DOI:https://doi.org/10.1016/j.jval.2020.11.022

      Highlights

      • This study has utilized repeated health status surveys of the SF-36 to separate the effect of smoking cessation on physical health and mental health, which was not able to obtain by the previous studies..
      • Smoking cessation has a heterogeneous effect on different aspects of health-related quality of life, positive effect on physical and general health, but nonsignificant effect on mental aspects, which helps explain the inconsistent and sometimes contradictory reports within the published literature.
      • The study also reports affects of cessation on SF-6D, but this instrument shows little change to be a sensitive preference-based index measure to elicit utility values for smoking cessation interventions in healthcare evaluations and economic modelings.

      Abstract

      Objectives

      A number of studies have shown an association between smoking habit and quality of life, but these have mainly involved cross-sectional data. This study takes advantage of longitudinal panel data to estimate the effect of the transition from “smoker” to “ex-smoker” status (smoking cessation) on health-related quality of life (HRQoL), measured by SF-36, in an Australian general population sample.

      Methods

      Panel data from 13 waves (2001-2013) of a nationally representative longitudinal survey of Household Income and Labour Dynamics of Australia (HILDA) were used; 1858 respondents (5% of total HILDA sample) who experienced only 1 cessation event in their HILDA life were selected. HRQoL trajectories elicited by SF-36 (0-100 scale, worst to best health) were modeled before and after cessation events using a piecewise (segmented) 2-way fixed-effect linear regression, adopted to capture within-person differences. This enabled measurement of changes of regression slopes and intercept while controlling time-invariant characteristics (eg, country of birth, gender) and time-varying changes in health status.

      Results

      Annual pre-post intervention improvements were estimated for the following dimensions: role physical 0.65 (95% CI 0.62-1.24), bodily pain 0.48 (95% CI 0.10-0.86), general health 0.55 (95% CI 0.2-0.9), and the physical component summary score 0.22 (95% CI 0.01-0.04). Immediate effects (discontinuity at the time of cessation) of smoking cessation existed for bodily pain –1.5 (95% CI –2.52 to –0.40) and general health 1.82 (95% CI 1.01-2.62). The effects for mental health domains were not significant.

      Conclusions

      Adjusting for all unmeasured time-invariant confounders and controlling the effect of time, this study revealed the varied effects of smoking cessation on HRQoL; it has positive effect on physical and general health but nonsignificant effect on mental aspects. Preference-based utility measures based on SF-6D capture changes that can be measured in several of the domains of the SF-36.

      Keywords

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