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Letters |

Cost-effectiveness of the AHCPR Guidelines for Smoking

Kevin M. Fosnocht, MD
JAMA. 1998;279(11):836-837. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-11-jac80001.
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To the Editor.—In demonstrating the cost-effectiveness of AHCPR guidelines for smoking cessation, Dr Cromwell and colleagues1 provide yet another weapon in the arsenal of the health practitioner to combat smoking. However, the authors' statement, "Even when cessation leads to health benefits, these benefits are delayed many years," was both disappointing and incorrect.

Several studies have demonstrated a very early health benefit in reducing the leading cause of death in this country, coronary artery disease. Rosenberg and colleagues2 reported that in male smokers younger than 55 years nearly half the excess risk of nonfatal myocardial infarction attributable to cigarette smoking is eliminated after quitting for 1 year, with the relative risk nearly 1.0 within 3 years of quitting. Similar results have been demonstrated in women.3 In a population-based case-control study, Dobson and colleagues4 reported the risk of a coronary event (including myocardial infarction and coronary heart disease death) in former smokers declines rapidly after quitting and within 2 to 3 years is similar to the risk of nonsmokers. Lightwood and Glantz5 estimated that 924 fewer hospitalizations for acute myocardial infarction would occur within the first year of a 1% reduction in smoking prevalence, resulting in an immediate savings of $44 million.

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