Background:The economic consequences of premature death and preventable illness are considerable.
The National Institute for Health and Care Excellence (NICE) in England has developed return on investment (ROI) tools to enable the determination of the cost impact and ROI of public-health interventions and therefore to maximise the health benefits of local services relative to the resources available.

Objectives:To make the economic case for investing in local stop-smoking services.

Methods: NICE’s tobacco ROI tool was used to estimate the number of additional quitters that the local stop-smoking services can produce compared with no such services and the ROI. The data on current use of services covers 1 April 2013 to 31 March 2014 and reported that of the 8 456 877 smokers in England in 2013 – 14 583 525 (6·9%) used local stop-smoking services. The impact was assessed using a lifetime and 2-year time horizon and 3.5% discount rate and taking a healthcare and productivity perspective.

Results: Stop-smoking services led to an additional 89 852 quitters in 2013-2014 (11 per 1000 smokers) at a cost of £109 million. In the first 2 years, these services saved a total of £56,327,113. This is the potential (gross) saving and does not include the cost of implementing the services. The potential savings included 230 617 fewer lost days, 185 561 fewer GP consultations, 53 126 fewer practice nurse consultations, 33 302 fewer outpatient visits, 6599 fewer hospital admissions and 102 436 fewer prescriptions. Over a lifetime, this investment will result in a gain of 6.8 QALYs per 1000 smokers (57 619 QALYs across England). For every £1 invested, £2.37 will be saved on treating smoking-related diseases and reduced productivity, and £12.87 will be saved overall if QALY gains are valued at £20 000 per QALY.

Conclusions: Recent estimates put the total cost of smoking to society in England at approximately £13.9 billion per year. The ROI tool demonstrates that investment in local stop-smoking services in England will lead to improved health and reduced healthcare expenditure as well as improved productivity to society.