BACKGROUND: In the Fit2Quit randomised controlled trial, insufficiently-active adult cigarette smokers who contacted Quitline for support to quit smoking were randomised to usual Quitline support or to also receive < 10 face-to-face and telephone exercise-support sessions delivered by trained exercise facilitators over the 24-week trial. This paper aims to determine the cost-effectiveness of an exercise-counselling intervention added to Quitline compared to Quitline alone in the Fit2Quit trial. METHODS: Within-trial and lifetime cost-effectiveness were assessed. A published Markov model was adapted, with smokers facing increased risks of lung cancer and cardiovascular disease. RESULTS: Over 24 weeks, the incremental programme cost per participant in the intervention was NZ$428 (US$289 or 226; purchasing power parity-adjusted (PPP)). The incremental cost-effectiveness ratio (ICER) for seven-day point prevalence measured at 24-week follow-up was NZ$31,733 (US$21,432 or 16,737 PPP-adjusted) per smoker abstaining. However, for the 52% who adhered to the intervention (> 7 contacts), the ICER for point prevalence was NZ$3,991 (US$2,695 or 2,105 PPP-adjusted). In this adherent subgroup, the Markov model estimated 0.057 and 0.068 discounted quality-adjusted life-year gains over the lifetime of 40-year-old males (ICER NZ$4,431; US$2,993 or 2,337 PPP-adjusted) and females (ICER NZ$2,909; US$1,965 or 1,534 PPP-adjusted). CONCLUSIONS: The exercise-counselling intervention will only be cost-effective if adherence is a minimum of > 7 intervention calls, which in turn leads to a sufficient number of quitters for health gains. TRIAL REGISTRATION: Australasian Clinical Trials Registry number ACTRN12609000637246.

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