RESUMO
AIMS: To conduct a systematic review and meta-analysis and pool the incremental net benefits (INBs) of varenicline compared with behaviour support with bupropion or nicotine replacement therapy (NRT), behaviour support alone and unaided cessation in adult smokers making a first-time attempt to quit. METHODS: A search for economic evaluation studies was conducted from inception to 30 September 2022, on PubMed, Embase, Cost-Effectiveness Analysis (CEA) Registry by Tufts Medical Centre, EconLit and the NHS Economic Evaluation Database (NHS EED). Eligible studies were included if they were (1) conducted among adults ages 18 years old and older who were smokers attempting to quit for the first time; (2) compared varenicline to behaviour support with bupropion or NRT, behaviour support alone and unaided cessation; and (3) performed a CEA or cost-utility analysis. The INBs were calculated and pooled across studies stratified by country income level and study perspective using the random-effects model. Statistical heterogeneity between studies was assessed using the I2 statistic and Cochrane Q statistic. RESULTS: Of the 1433 identified studies, 18 studies were included in our review. Our findings from healthcare system/payer perspective suggested that the use of varenicline is statistically significantly cost-effective compared with bupropion (pooled INB, $830.75 [95% confidence interval, $208.23, $1453.28]), NRTs ($636.16 [$192.48, $1079.84]) and unaided cessation ($4212.35 [$1755.79, $6668.92]) in high-income countries. Similarly, varenicline is also found to be cost-effective compared to bupropion ($2706.27 [$1284.44, $4128.11]), NRTs ($3310.01 [$1781.53, $4838.50]) and behavioural support alone ($5438.22 [$4105.99, $6770.46]) in low- and middle-income countries. CONCLUSION: Varenicline is cost-effective as a smoking cessation aid when compared with behavioural support with bupropion or nicotine replacement therapies and behavioural support alone in both high-income countries and low- and middle-income countries, from the healthcare system/payer perspective in adult smokers who attempt to quit for the first time.
Assuntos
Bupropiona , Análise Custo-Benefício , Agentes de Cessação do Hábito de Fumar , Abandono do Hábito de Fumar , Vareniclina , Humanos , Vareniclina/uso terapêutico , Vareniclina/economia , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/economia , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Agentes de Cessação do Hábito de Fumar/economia , Bupropiona/uso terapêutico , Bupropiona/economia , Dispositivos para o Abandono do Uso de Tabaco/economia , Terapia Comportamental/economia , Terapia Comportamental/métodos , AdultoRESUMO
OBJECTIVES: Smoking is a leading cause of death worldwide. Cessation aids include varenicline, bupropion, nicotine replacement therapy (NRT), and e-cigarettes at various doses (low, standard and high) and used alone or in combination with each other. Previous cost-effectiveness analyses have not fully accounted for adverse effects nor compared all cessation aids. The objective was to determine the relative cost-effectiveness of cessation aids in the United Kingdom. METHODS: An established Markov cohort model was adapted to incorporate health outcomes and costs due to depression and self-harm associated with cessation aids, alongside other health events. Relative efficacy in terms of abstinence and major adverse neuropsychiatric events was informed by a systematic review and network meta-analysis. Base case results are reported for UK-licensed interventions only. Two sensitivity analyses are reported, one including unlicensed interventions and another comparing all cessation aids but removing the impact of depression and self-harm. The sensitivity of conclusions to model inputs was assessed by calculating the expected value of partial perfect information. RESULTS: When limited to UK-licensed interventions, varenicline standard-dose and NRT standard-dose were most cost-effective. Including unlicensed interventions, e-cigarette low-dose appeared most cost-effective followed by varenicline standard-dose + bupropion standard-dose combined. When the impact of depression and self-harm was excluded, varenicline standard-dose + NRT standard-dose was most cost-effective, followed by varenicline low-dose + NRT standard-dose. CONCLUSION: Although found to be most cost-effective, combined therapy is currently unlicensed in the United Kingdom and the safety of e-cigarettes remains uncertain. The value-of-information analysis suggested researchers should continue to investigate the long-term effectiveness and safety outcomes of e-cigarettes in studies with active comparators.
Assuntos
Depressão/epidemiologia , Custos de Medicamentos , Sistemas Eletrônicos de Liberação de Nicotina/economia , Comportamento Autodestrutivo/epidemiologia , Agentes de Cessação do Hábito de Fumar/efeitos adversos , Agentes de Cessação do Hábito de Fumar/economia , Abandono do Hábito de Fumar/economia , Fumar/efeitos adversos , Dispositivos para o Abandono do Uso de Tabaco/efeitos adversos , Dispositivos para o Abandono do Uso de Tabaco/economia , Bupropiona/efeitos adversos , Bupropiona/economia , Análise Custo-Benefício , Depressão/economia , Depressão/psicologia , Humanos , Cadeias de Markov , Modelos Econômicos , Método de Monte Carlo , Metanálise em Rede , Agonistas Nicotínicos/efeitos adversos , Agonistas Nicotínicos/economia , Anos de Vida Ajustados por Qualidade de Vida , Recidiva , Medição de Risco , Fatores de Risco , Comportamento Autodestrutivo/economia , Comportamento Autodestrutivo/psicologia , Fumar/economia , Fumar/mortalidade , Fatores de Tempo , Resultado do Tratamento , Reino Unido/epidemiologia , Vareniclina/efeitos adversos , Vareniclina/economiaRESUMO
INTRODUCTION: Varenicline (VAR) is an effective smoking-cessation therapy compared to the commonly used nicotine-replacement therapy patch (NRT-P). However, comparative real-world evidence on smoking-cessation therapies is limited, especially for economic outcomes. METHODS: Using national claims databases (2012-2016) in the United States (US), adults initiating VAR or NRT-P without use of any other smoking-cessation products were followed for up to 1 year on a quarterly basis. Outcomes included smoking-attributable (SA) (cardiovascular, diabetes, pulmonary diseases, and smoking cessation) and all-cause costs (2017 US dollars). Adjusted mean costs were estimated from multivariable regressions, with baseline characteristics and propensity scores as covariates. Annual adjusted costs were calculated from quarterly averages. RESULTS: The VAR cohort (n = 209,284) was younger (mean age 46.7 vs. 49.0 years) and had fewer comorbidities [mean Charlson Comorbidity Index (CCI): 0.8 vs. 1.6] than the NRT-P cohort (n = 34,593). After adjustment, VAR cohort had lower SA and all-cause medical costs than NRT-P cohort in Quarters 1-4 (Q1-Q4) of follow-up, and had lower SA and all-cause total costs in Q2-Q4. Annually, VAR cohort had higher SA total costs ($307) and lower all-cause costs (- $2089) than NRT-P cohort. Annual medical costs were lower in VAR cohort (- $640 for SA and - $2876 for all-cause), and pharmacy costs were higher ($762 for SA and $777 for all-cause). In adherent patients (VAR: n = 38,744; NRT-P: n = 2702), VAR patients had lower annual medical costs (- $794 for SA and - $1636 for all-cause) and higher pharmacy costs ($1175 for SA and $1269 for all-cause); differences in SA and all-cause total costs were not statistically significant between treatment groups. CONCLUSIONS: Lower SA and all-cause medical costs associated with the use of VAR versus NRT-P resulted in savings in all-cause total costs and, among adherent patients, potentially offset the high pharmacy costs of VAR. FUNDING: Pfizer, Inc.
Assuntos
Custos de Cuidados de Saúde , Abandono do Hábito de Fumar/economia , Dispositivos para o Abandono do Uso de Tabaco/economia , Vareniclina/economia , Adulto , Terapia Comportamental/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumar/economia , Estados UnidosRESUMO
BACKGROUND AND AIMS: Smoking cessation medications are effective, but often underutilized because of costs and side effects. Cytisine is a plant-based smoking cessation medication with more than 50 years of use in central and eastern Europe. While cytisine has been found to be well-tolerated and more effective than nicotine replacement therapy, direct comparisons with varenicline have not been conducted. This study evaluates the effectiveness, safety and cost-effectiveness of cytisine compared with varenicline. DESIGN: Two-arm, parallel group, randomized, non-inferiority trial, with allocation concealment and blinded outcome assessment. SETTING: Australian population-based study. PARTICIPANTS: Adult daily smokers (n = 1266) interested in quitting will be recruited through advertisements and Quitline telephone-based cessation support services. INTERVENTION AND COMPARATOR: Eligible participants will be randomized (1 : 1 ratio) to receive either cytisine capsules (25-day supply) or varenicline tablets (12-week supply), prescribed in accordance with the manufacturer's recommended dosing regimen. The medication will be mailed to each participant's nominated residential address. All participants will also be offered standard Quitline behavioural support (up to six 10-12-minute sessions). MEASUREMENTS: Assessments will be undertaken by telephone at baseline, 4 and 7 months post-randomization. Participants will also be contacted twice (2 and 4 weeks post-randomization) to ascertain adverse events, treatment adherence and smoking status. The primary outcome will be self-reported 6-month continuous abstinence from smoking, verified by carbon monoxide at 7-month follow-up. We will also evaluate the relative safety and cost-effectiveness of cytisine compared with varenicline. Secondary outcomes will include self-reported continuous and 7-day point prevalence abstinence and cigarette consumption at each follow-up interview. COMMENTS: If cytisine is as effective as varenicline, its lower cost and natural plant-based composition may make it an acceptable and affordable smoking cessation medication that could save millions of lives world-wide.
Assuntos
Alcaloides/economia , Alcaloides/uso terapêutico , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/métodos , Vareniclina/economia , Vareniclina/uso terapêutico , Adulto , Alcaloides/efeitos adversos , Austrália , Azocinas/efeitos adversos , Azocinas/economia , Azocinas/uso terapêutico , Análise Custo-Benefício , Método Duplo-Cego , Estudos de Equivalência como Asunto , Feminino , Humanos , Masculino , Quinolizinas/efeitos adversos , Quinolizinas/economia , Quinolizinas/uso terapêutico , Resultado do Tratamento , Vareniclina/efeitos adversosRESUMO
BACKGROUND: Smoking is a known risk factor for postoperative complications after colectomy. Using the perspective of the provider, this study evaluated the cost-effectiveness of the pharmacologic interventions for smoking cessation. METHODS: A decision tree model was constructed to represent a provider's decision to provide either bupropion, nicotine replacement therapy, varenicline, or no cessation therapy to all patients presenting for elective colectomy. Incremental cost per quality-adjusted life year (QALY) was the primary outcome. RESULTS: The base case analysis suggests that bupropion is cost-effective with an incremental cost-effectiveness ratio of approximately $75,000 per QALY. Sensitivity analyses established ranges for which each medication might be cost-effective and dominant compared to offering no cessation therapy. CONCLUSIONS: From a provider perspective, offering bupropion for smoking cessation to patients scheduled for elective colon resection is cost-effective. Furthermore, these results provide benchmarks to inform providers about whether targeted, short-term smoking cessation therapies represent good value in colectomies.
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Colectomia/efeitos adversos , Custos de Cuidados de Saúde , Complicações Pós-Operatórias/prevenção & controle , Agentes de Cessação do Hábito de Fumar/economia , Abandono do Hábito de Fumar/economia , Dispositivos para o Abandono do Uso de Tabaco/economia , Bupropiona/economia , Bupropiona/uso terapêutico , Colectomia/economia , Análise Custo-Benefício , Árvores de Decisões , Procedimentos Cirúrgicos Eletivos , Humanos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Vareniclina/economia , Vareniclina/uso terapêuticoRESUMO
BACKGROUND AND AIMS: Smoking gives rise to many cross-sectorial public costs and benefits for government. Costs arise from increased healthcare spending and work-related social benefits, while smoking itself provides significant revenue for government from tobacco taxes. To better understand the public economic impact of smoking and smoking cessation therapies, this study developed a government perspective framework for assessing smoking-attributable morbidity and mortality and associated public costs. This framework includes changes in lifetime tax revenue and health costs, as well as changes in tobacco tax revenue, from fewer smokers. METHODS: A modified generational accounting framework was developed to assess relationships between smoking-attributable morbidity and mortality and public economic consequences of smoking, including lifetime tax revenue gains/losses, government social transfers, and health spending. Based on the current prevalence of smoking in South Korean males, a cohort model was developed for smokers, former-smokers, and never-smokers. The model simulated the lifetime discounted fiscal transfers for different age cohorts in 5 year age bands, and the return on investment (ROI) from smoking cessation therapy. RESULTS: Former smokers are estimated to generate higher lifetime earnings and direct tax revenues and lower lifetime healthcare costs due to the reduction of smoking-attributable mortality and morbidity compared to smokers, even after accounting for reduced tobacco taxes paid. Based on the costs of public investments in varenicline, this study estimated a ROI from 1.4-1.7, depending on treatment age, with higher ROI in younger cohorts, with an average ROI of 1.6 for those aged less than 65. CONCLUSIONS: This analysis suggests that reductions in smoking can generate positive public economic benefits for government, even after accounting for lost tobacco tax revenues. The results described here are likely applicable to countries having similar underlying smoking prevalence, comparable taxation rates, and social benefit protection provided to individuals with smoking-related conditions.
Assuntos
Agonistas Nicotínicos/uso terapêutico , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/métodos , Fumar/economia , Vareniclina/uso terapêutico , Adulto , Idoso , Comorbidade , Eficiência , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Mortalidade Prematura , Agonistas Nicotínicos/economia , República da Coreia , Salários e Benefícios/estatística & dados numéricos , Fumantes , Fumar/efeitos adversos , Impostos/estatística & dados numéricos , Vareniclina/economiaRESUMO
The ALAT and SEPAR Treatment and Control of Smoking Groups have collaborated in the preparation of this document which attempts to answer, by way of PICO methodology, different questions on health interventions for helping COPD patients to stop smoking. The main recommendations are: (i)moderate-quality evidence and strong recommendation for performing spirometry in COPD patients and in smokers with a high risk of developing the disease, as a motivational tool (particularly for showing evidence of lung age), a diagnostic tool, and for active case-finding; (ii)high-quality evidence and strong recommendation for using intensive dedicated behavioral counselling and drug treatment for helping COPD patients to stop smoking; (iii)high-quality evidence and strong recommendation for initiating interventions for helping COPD patients to stop smoking during hospitalization with improvement when the intervention is prolonged after discharge, and (iv)high-quality evidence and strong recommendation for funding treatment of smoking in COPD patients, in view of the impact on health and health economics.
Assuntos
Medicina Baseada em Evidências/métodos , Doença Pulmonar Obstrutiva Crônica/psicologia , Abandono do Hábito de Fumar/psicologia , Fumar/psicologia , Espirometria/psicologia , Biomarcadores , Bupropiona/economia , Bupropiona/uso terapêutico , Ensaios Clínicos como Assunto , Análise Custo-Benefício , Aconselhamento/economia , Aconselhamento/métodos , Humanos , Motivação , Nicotina/economia , Nicotina/uso terapêutico , Agonistas Nicotínicos/economia , Agonistas Nicotínicos/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fumar/tratamento farmacológico , Fumar/economia , Fumar/terapia , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/métodos , Inquéritos e Questionários , Vareniclina/economia , Vareniclina/uso terapêuticoRESUMO
BACKGROUND: African-American smokers experience disproportionate COPD morbidity. As a front-line COPD behavioral management strategy, smoking cessation is less prevalent among African-American smokers. Identifying barriers and predictors to smoking cessation in this population is important to bridging this disparity. METHODS: In this study, the predictors of enrollment and attendance to a 3-session urban hospital smoking cessation program were examined. A retrospective chart review was conducted for all pulmonary clinic patients who smoked and were referred to the cessation program between June 2013 and May 2014. Demographic, smoking behavior, cardiopulmonary, and health status variables were extracted (N = 253). Second, a qualitative assessment of the beliefs and barriers for smoking cessation and physical activity were examined in a sub-sample of the population (n = 41). RESULTS: One-hundred forty-seven of the pulmonary subjects (58%) enrolled in the cessation program, and 40 attended all sessions (16% of the total sample). Participants with COPD (odds ratio = 4.65, P = .030), or had a mother who had cancer (odds ratio = 4.49, P = .027), were more likely to attend the program. Qualitatively, pulmonary care patients who wanted to quit smoking and be more physically active cited: strong beliefs about the inability to engage in these behaviors, belief that quitting and increased activity might exacerbate poor health, and an inability to obtain pharmacotherapy as barriers to adopting these behaviors. CONCLUSIONS: Smoking cessation program attendance in this sample of mostly African-American smokers was poor. Increased knowledge about cessation benefits and access to full-course pharmacotherapy, particularly in those without a COPD diagnosis and who do not have a maternal history of cancer, may be high-priority targets to promote cessation program uptake in this population. Increased knowledge and access to safe forms of physical activity may also be beneficial.
Assuntos
Negro ou Afro-Americano/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Cooperação do Paciente , Preferência do Paciente , Abandono do Hábito de Fumar/psicologia , Idoso , Doença da Artéria Coronariana/psicologia , Exercício Físico , Feminino , Comportamentos Relacionados com a Saúde , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Agonistas Nicotínicos/economia , Doença Pulmonar Obstrutiva Crônica/psicologia , Estudos Retrospectivos , Fumar , Abandono do Hábito de Fumar/métodos , Vareniclina/economiaRESUMO
AIMS: The study aimed to assess the budgetary impact (BI) of reimbursing varenicline in patients with chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (t2-DM) or cardiovascular diseases (CVD). METHODS: The BI was estimated comparing the current non-reimbursed scenario versus a projected reimbursed scenario using the Spanish National Health System (SNHS) perspective. A hybrid model was developed using epidemiological data and Markov chains to estimate smoking cessation rates with varenicline during a 5-year horizon. Costs of cessation were considered in the reimbursement scenario only. Efficacy, expressed as a 1-year continuous abstinence rate, was derived from clinical trials. Cost savings due to smoking cessation were extracted from local cost-of-illness studies. Results are shown as incremental cost savings. Univariate sensitivity analysis was also applied. RESULTS: A total of 68,684 patients stopped smoking in the reimbursed scenario compared with 15,208 without reimbursement. In the reimbursed scenario, total savings accounted for 36.3 million, showing 14.6 million accumulated additional savings compared with the scenario without reimbursement. Sensitivity analyses showed results to be robust with monetary savings starting in the third year of modeling. CONCLUSION: Reimbursement of varenicline in smoking cessation is a cost-effective health policy in the SNHS in COPD, t2-DM or CVD, and could produce cost savings starting in the third year of implementation.
Assuntos
Doenças Cardiovasculares/economia , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/economia , Reembolso de Seguro de Saúde/economia , Doença Pulmonar Obstrutiva Crônica/economia , Abandono do Hábito de Fumar/economia , Vareniclina/economia , Adulto , Idoso , Doenças Cardiovasculares/psicologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econômicos , Doença Pulmonar Obstrutiva Crônica/psicologia , Abandono do Hábito de Fumar/métodos , EspanhaRESUMO
OBJECTIVE: One quit attempt with varenicline has been found to be a cost-effective smoking cessation intervention. The purpose of this study was to analyze varenicline's cost-effectiveness in patients who relapse during or after the first treatment. A comparison was made between re-treatment schema with varenicline and re-treatment schema with bupropion, NRT and unaided cessation, and treatment once with varenicline in a Finnish context. METHODS: The two-quit version of BENESCO Markov model was used to follow a cohort of smokers making up to two quit attempts over a lifetime. The abstinence rates of the interventions were derived from a Cochrane review. Gender- and age-specific data on the incidence and prevalence of five smoking-related diseases were included in the model. Quality-adjusted life-years, total expected costs, and the lifetime cumulative incidence of smoking-related morbidities and mortality were the primary outcomes evaluated. RESULTS: The study cohort comprised 116,533 smokers who were willing to make a quit attempt. In the lifetime simulation, re-treatment with varenicline yielded 6,150-20,250 extra quitters, depending on the comparator. Among these quitters it was possible to prevent 899-2,972 additional cases of smoking-related diseases, and 395-1,307 deaths attributable to smoking. Re-treatment with varenicline resulted in cost savings of up to 54.9 million Euros. Re-treatment with varenicline dominated all the other smoking cessation interventions used in the analysis. Sensitivity analysis supported the robustness of the base case results. LIMITATIONS: The analysis did not consider adverse events, and included only five major smoking-related diseases, which is a conservative approach, and probably leads to under-estimation of cost-effectiveness of cessation interventions. Furthermore, assumptions of constant relative risks for smoking-related diseases for each smoking status and the proxy values used as efficacy estimates of second quit attempts for other interventions than varenicline are limitations. CONCLUSIONS: A second quitting effort with varenicline is economically justifiable.
Assuntos
Agonistas Nicotínicos/administração & dosagem , Agonistas Nicotínicos/economia , Abandono do Hábito de Fumar , Vareniclina/administração & dosagem , Vareniclina/economia , Adolescente , Adulto , Idoso , Análise Custo-Benefício , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Retratamento , Adulto JovemRESUMO
BACKGROUND: Smoking cessation is a challenging task with a high risk of relapse. Depending on the choice of medication and duration of therapy, the costs of using a smoking cessation aid can be high. Additionally, these costs are not covered by health insurance in Germany. Information on willingness to use (WTU) and willingness to pay (WTP) for smoking cessation aids is valuable for developing different smoking cessation strategies. OBJECTIVES: The study analyses WTU and WTP for three pharmacological smoking cessation aids (nicotine replacement therapy (NRT), bupropion and varenicline) among young and middle-aged adults in Germany and attempts to determine their major driving factors. METHODS: Two cross-sectional internet-based surveys of smokers over 18 years of age were conducted in 2014 and 2015 in Germany. Respondents were asked about smoking-related issues and WTU and WTP for each therapy. The contingent valuation method with payment cards was used to measure WTP. Descriptive statistics, logistical regression and accelerated failure-time regression models were performed. RESULTS: The total sample size is 505. Half of the respondents are willing to use NRT and one-third are willing to use bupropion and/or varenicline. WTU induces positive WTP; however, the magnitude of WTP is beneath the market price. WTU significantly increases with a higher addiction level and if smokers have previously heard about the therapy. CONCLUSION: This study indicates different points to be considered for policy development. Promotion information and improving awareness about medication aids might increase WTU, and development of monetary incentives for young smokers could create a better chance for successful smoking cessation.
Assuntos
Bupropiona/economia , Financiamento Pessoal/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Abandono do Hábito de Fumar/economia , Dispositivos para o Abandono do Uso de Tabaco/economia , Vareniclina/economia , Adulto , Idoso , Bupropiona/uso terapêutico , Análise Custo-Benefício , Estudos Transversais , Inibidores da Captação de Dopamina/economia , Inibidores da Captação de Dopamina/uso terapêutico , Feminino , Financiamento Pessoal/estatística & dados numéricos , Alemanha , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Agonistas Nicotínicos/economia , Agonistas Nicotínicos/uso terapêutico , Abandono do Hábito de Fumar/métodos , Dispositivos para o Abandono do Uso de Tabaco/efeitos adversos , Vareniclina/uso terapêutico , Adulto JovemRESUMO
INTRODUCTION: In the Netherlands, pharmacologic Smoking Cessation Treatments (pSCTs) were reimbursed in 2011. In 2012 the reimbursement was discontinued. As of 2013, pSCTs were again reimbursed, provided they are accompanied by behavioral counseling. The aim of this article is to assess the impact of changes in reimbursement policy on use of-and adherence to-pSCTs. METHODS: A retrospective dispensing database analysis was performed on real-world observational data (2010-2013) from the Netherlands. Data on use and adherence was collected, in patients who were dispensed bupropion or varenicline in community pharmacies for the first time. Using the InterActionDataBase (iadb.nl), adherence per patient that initiated varenicline or bupropion was calculated by adding up all dispenses between initiation of the therapy and the 120 days thereafter. Good adherence was defined as using minimal 80% of the recommended duration and intensity of use. RESULTS: The prevalence of patients initiating pSCTs was stable at 0.4 per 1000 inhabitants per quarter during 2010. In 2011, the prevalence was on average 0.7, with peaks in the first (0.8 per 1000) and fourth (1.0 per 1000) quarters of 2011. In 2012, the prevalence was stable again at 0.3. In 2013, prevalence was on average 0.4, with a small peak in the first quarter. Adherence was 15.4% in 2010 versus 20.1% in 2011 (P = .002). In 2012, adherence was 13.9%, compared with 18.9% in 2013 (P = .008). CONCLUSIONS: Not only the likelihood of initiating pSCTs, but also the extent of adherence to these treatments, although generally low, seems higher during reimbursement.
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Bupropiona/economia , Reembolso de Seguro de Saúde , Adesão à Medicação , Abandono do Hábito de Fumar/economia , Prevenção do Hábito de Fumar , Vareniclina/economia , Adulto , Bupropiona/uso terapêutico , Aconselhamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Retrospectivos , Fumar/psicologia , Abandono do Hábito de Fumar/métodos , Dispositivos para o Abandono do Uso de Tabaco , Vareniclina/uso terapêuticoRESUMO
AIMS: Clinical smoking cessation interventions have been found typically to be highly cost-effective in many high-income countries. There is a need to extend this to low- and middle-income countries and undertake comparative analyses. This study aimed to estimate the incremental cost-effectiveness ratio of a range of clinical smoking cessation interventions available in Thailand. METHODS: Using a Markov model, cost-effectiveness, in terms of cost per quality-adjusted life years (QALY) gained, from a range of interventions was estimated from a societal perspective for males and females aged 40 years who smoke at least 10 cigarettes per day. Interventions considered were: counselling in hospital, phone counselling (Quitline) and counselling plus nicotine gum, nicotine patch, bupropion, nortriptyline or varenicline. An annual discounting rate of 3% was used. Probabilistic sensitivity analyses were conducted and a cost-effectiveness acceptability curve (CEAC) plotted. Comparisons between interventions were conducted involving application of a 'decision rule' process. RESULTS: Counselling with varenicline and counselling with nortriptyline were found to be cost-effective. Hospital counselling only, nicotine patch and bupropion were dominated by Quitline, nortriptyline and varenicline, respectively, according to the decision rule. When compared with unassisted cessation, probabilistic sensitivity analysis revealed that all interventions have very high probabilities (95%) of being cost-saving except for nicotine replacement therapy (NRT) patch (74%). CONCLUSION: In middle-income countries such as Thailand, nortriptyline and varenicline appear to provide cost-effective clinical options for supporting smokers to quit.
Assuntos
Abandono do Hábito de Fumar/economia , Fumar/economia , Adulto , Terapia Combinada/economia , Análise Custo-Benefício , Aconselhamento/economia , Árvores de Decisões , Feminino , Humanos , Masculino , Agonistas Nicotínicos/economia , Agonistas Nicotínicos/uso terapêutico , Nortriptilina/economia , Nortriptilina/uso terapêutico , Qualidade de Vida , Prevenção do Hábito de Fumar , Tailândia , Dispositivos para o Abandono do Uso de Tabaco , Vareniclina/economia , Vareniclina/uso terapêuticoRESUMO
BACKGROUND: Smoking cessation medications have been shown to yield higher success rates and sustained abstinence than unassisted quit attempts. In Japan, the treatments available include nicotine replacement therapy (NRT) and varenicline; however, unassisted attempts to quit smoking remain common. OBJECTIVE: The objective of this study was to compare the health and economic consequences in Japan of using pharmacotherapy to support smoking cessation with unassisted attempts and the current mix of strategies used. METHODS: A discrete-event simulation that models lifetime quitting behaviour and includes multiple quit attempts (MQAs) and relapses was adapted for these analyses. The risk of developing smoking-related diseases is estimated based on the duration of abstinence. Data collected from a survey conducted in Japan were used to determine the interventions selected by smokers initiating a quit attempt and the time between MQAs. Direct and indirect costs are assessed (expressed in 2014 Japanese Yen). RESULTS: Using pharmacotherapy (NRT or varenicline) to support quit attempts proved to be dominant when compared with unassisted attempts or the current mix of strategies (most are unassisted). The results of stratified analyses by age imply that smoking cessation improves health outcomes across all generations. Indirect costs due to premature death leading to lost wages are an important component of the total costs, exceeding the direct medical cost estimates. CONCLUSIONS: Increased utilisation of smoking cessation pharmacotherapy to support quit attempts is predicted to lead to an increase in the number of smokers achieving abstinence, and provide improvements in health outcomes over a lifetime with no additional costs.
Assuntos
Análise Custo-Benefício/métodos , Abandono do Hábito de Fumar/economia , Adolescente , Adulto , Idoso , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Fumar/efeitos adversos , Fumar/economia , Abandono do Hábito de Fumar/métodos , Dispositivos para o Abandono do Uso de Tabaco/economia , Vareniclina/economia , Vareniclina/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: Smoking is the leading risk factor for preventable morbidity and mortality as a result of heart and lung diseases and various forms of cancer. Reimbursement coverage for smoking cessation therapies remains limited in Canada and the United States despite the health and economic benefits of smoking cessation. OBJECTIVES: This study aimed to evaluate the long-term cost-effectiveness of varenicline compared with other smoking cessation interventions in Canada using the Benefits of Smoking Cessation on Outcomes (BENESCO) model. METHODS: Efficacy rates of the standard course (12 weeks) varenicline, extended course (12 + 12 weeks) varenicline, bupropion, nicotine replacement therapy and unaided intervention were derived based on a published mixed treatment comparison methodology and analysed within a Markov cohort model to estimate their cost-effectiveness over the lifetime cycle. Study cohort, smoking rates and prevalence, incidence and mortality of smoking-related diseases were calibrated to represent the Canadian population. RESULTS: Over the subjects' lifetime, both the standard and the extended course of varenicline are shown to dominate (e.g. less costly and more effective) all other alternative smoking cessation interventions considered. Compared with the standard varenicline treatment course, the extended course is highly cost-effective with an incremental cost-effectiveness ratio (ICER) less than $4000 per quality-adjusted life year. Including indirect cost and benefits of smoking cessation interventions further strengthens the result with the extended course of varenicline dominating all other alternatives considered. LIMITATIONS: Evidence from complex smoking cessation models requiring numerous inputs and assumptions should be assessed in conjunction with evidence from other methodologies. CONCLUSIONS: The standard and extended courses of varenicline are decidedly cost-effective treatment regimes compared with alternative smoking cessation interventions and can provide significant cost savings to the healthcare system.