An economic evaluation of a computer-tailored e-learning program to promote smoking cessation counseling guideline adherence among practice nurses.
OBJECTIVE
To conduct an economic evaluation of a tailored e-learning program, which successfully improved practice nurses' smoking cessation guideline adherence.


METHODS
The economic evaluation was embedded in a randomized controlled trial, in which 269 practice nurses recruited 388 smoking patients. Cost-effectiveness was assessed using guideline adherence as effect measure on practice nurse level, and continued smoking abstinence on patient level. Cost-utility was assessed on patient level, using patients' Quality Adjusted Life Years (QALYs) as effect measure.


RESULTS
The e-learning program was likely to be cost-effective on practice nurse level, as adherence to an additional guideline step cost €1,586. On patient level, cost-effectiveness was slightly likely after six months (cost per additional quitter: €7,126), but not after twelve months. The cost-utility analysis revealed slight cost-effectiveness (cost per QALY gained: €18,431) on patient level.


CONCLUSION
Providing practice nurses with a tailored e-learning program is cost-effective to improve their smoking cessation counseling. Though, cost-effectiveness on patient level was not found after twelve months, potentially resulting from smoking relapse.


PRACTICE IMPLICATIONS
Widespread implementation of the e-learning program can improve the quality of smoking cessation care in general practice. Strategies to prevent patients' smoking relapse should be further explored to improve patients' long-term abstinence.
['de Ruijter|Dennis|D|', 'Hoving|Ciska|C|', 'Evers|Silvia|S|', 'Hudales|Raesita|R|', 'de Vries|Hein|H|', 'Smit|Eline|E|']
D003194:Computer-Assisted Instruction D003362:Cost-Benefit Analysis D003376:Counseling D005260:Female D019983:Guideline Adherence D006801:Humans D008297:Male D008875:Middle Aged D009426:Netherlands D010353:Patient Education as Topic D057184:Practice Patterns, Nurses' D016540:Smoking Cessation
Economic evaluation E-learning Smoking cessation Guideline adherence Practice nurses Tailoring General practice Evidence-Based guideline