Where should we target our research effort? A data-based model for determining priorities for smoking cessation research and healthcare delivery in general practice

Background: Researchers and decision makers must constantly make decisions about how they allocate their limited time and health dollars across a number of health interventions and priorities. Given the scarcity of resources, it is critical that decisions are evidence based to give the best chance that the initiatives implemented will, with maximum efficiency, improve health outcomes. While complex mathematical models are available to inform such decision making, the skills required to perform sophisticated analyses are often outside the reach of those who need them. This paper presents a simple Excel-based calculator, readily accessible by policy makers and lay users, that can help inform the decision making process and the choices available to decision makers, while simultaneously highlighting important gaps in the available information. Aims: To demonstrate the utility of the data-based calculator in a test case, by comparing the relative effectiveness and cost-effectiveness of strategies to increase smoking cessation rates in the general practice setting. Methods: The data-based calculator comprises a simple spreadsheet in Microsoft Excel. Model parameters (effectiveness, prevalence and cost) were obtained from the literature and used to compare population health and cost outcomes for smoking cessation in general practice under three scenarios: baseline conditions, implementing an intervention to increase detection of smoking (option 1), and implementing an intervention to increase the effectiveness of smoking cessation support offered to smokers (option 2). Results: Under the model assumptions, option 1 produced more successful outcomes and was a more cost effective option than option 2. Conclusions: This Excel calculator presents an easily accessible tool to help researchers and others assess the cost effectiveness and reach of two different approaches for intervening on smoking in general practice. The model can be easily modified to allow different comparisons and may be helpful as a guide for making decisions about where to allocate research effort and funding.