{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T07:01:25Z","timestamp":1772002885434,"version":"3.50.1"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Smoking is a major public health concern in Tamil Nadu, as it is in many parts of the world. It is a leading cause of preventable diseases and deaths, with a significant economic burden on healthcare systems and society as a whole. Recognizing the need to address this issue, the implementation of smoking cessation strategies at primary health care (PHC) settings has gained attention. Conducting a cost-effectiveness analysis in this context can help policymakers and healthcare providers make informed decisions about the allocation of resources for such interventions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To compare the cost-effectiveness of the smoking cessation of proposed strategies (PSs), PS1: enhanced counselling (EC) + nicotine replacement therapy (NRT) + bupropion tablet; PS2: behavioural intervention (BI) + NRT + promotion of bupropion sustained release (SR); PS3: EC + NRT + promotion of bupropion SR with the current strategy (BI +NRT+ Bupropion) in a population of smokers aged \u226515 years attending the PHC in Tamil Nadu.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this hypothetical cohort of 100,000 individuals using the decision tree analysis, a cost-effectiveness assessment was conducted for both proposed and existing strategies. The results were evaluated in terms of incremental cost-effectiveness ratios (ICERs) per person quitting smoking. To assess the robustness of the findings, one-way sensitivity analysis and probabilistic sensitivity analysis were performed which aims to explore and address the uncertainties associated with the outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The cost of the current strategy (CS) was higher (\u20b9359 or $4.28 million) when compared with PS1 (\u20b9327 or $3.90 million) and PS3 (\u20b9327 or $3.90 million) strategies. The PS2 with BI + bupropion SR + NRT was found to be more cost (\u20b92,720,571 or $ 32,414.76) as compared to current strategy. ICER values indicates that compared to the current strategy, the PS1 and PS3 were found to be cost-saving, whereas the PS2 was found to be cost-effective. The cost-effectiveness acceptability curve demonstrated that the PS1 and PS3 indicates 100% probability of the intervention being cost-saving. After excluding dominated interventions (PS2 and CS), the remaining strategies (PS1 and PS3) were compared. The PS3, with an incremental cost of \u20b9462,497 ($5,510) for 131 additional quitters, resulted in an ICER of \u20b93,531 ($42) per quitter, making it a cost-effective option compared to PS1.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our study findings indicate that the need for healthcare providers and policymakers to implement PS3 with EC, NRT, Bupropion SR, as which was found to be cost-saving compared to current practices.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0318013","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T18:28:46Z","timestamp":1738175326000},"page":"e0318013","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost-effectiveness analysis for implementation of smoking cessation strategies at primary health care settings in Tamil Nadu"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0390-346X","authenticated-orcid":true,"given":"Vasantha","family":"Mahalingam","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramesh Kumar","family":"Santhanakrishnan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muniyandi","family":"Malaisamy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthick","family":"Chelvanayagam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavi","family":"Mathiyazhagan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adhin","family":"Bhaskar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karikalan","family":"Nagarajan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerard","family":"Maria Selvam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Surendran","family":"Veeraiah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavitha","family":"Rajsekar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirti","family":"Tyagi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ponnuraja","family":"Chinnaiyan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"issue":"3","key":"pone.0318013.ref001","doi-asserted-by":"crossref","first-page":"3","DOI":"10.53127\/tblg-2023-A020","article-title":"The WHO Framework Convention (FCTC) that changed tobacco control","volume":"21","author":"MS Cattaruzza","year":"2024","journal-title":"Tabaccologia"},{"issue":"3","key":"pone.0318013.ref002","doi-asserted-by":"crossref","first-page":"139","DOI":"10.4103\/0971-5851.103139","article-title":"An overview of the tobacco problem in India","volume":"33","author":"GA Mishra","year":"2012","journal-title":"Indian J Med Paediatr Oncol"},{"issue":"10100","key":"pone.0318013.ref003","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1016\/S0140-6736(17)32366-8","article-title":"Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"GBD 2016 Risk Factors Collaborators","year":"2017","journal-title":"Lancet"},{"key":"pone.0318013.ref004","unstructured":"Global Adult Tobacco Survey GATS 2 India 2016\u201317. 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