title: Smoking-cessation therapy using varenicline: the cost-utility of an additional 12-week course of varenicline for the maintenance of smoking abstinence. A Discrete-Event Simulation of Smoking-Cessation Strategies Based on Varenicline Pivotal Trial Data Cost-effectiveness of the Danish smoking cessation interventions Cost-effectiveness of varenicline compared with nicotine patches for smoking cessation--results from four European countries. An Employer-Based Cost-Benefit Analysis of a Novel Pharmacotherapy Agent for Smoking Cessation Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling Cost-Utility Analysis of Varenicline, an Oral Smoking-Cessation Drug, in Japan Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness If you try to stop smoking, should we pay for it? The cost-utility of reimbursing smoking cessation support in the Netherlands. Cost Effectiveness of Varenicline in Belgium, Compared with Bupropion, Nicotine Replacement Therapy, Brief Counselling and Unaided Smoking Cessation Comparison of the cost-effectiveness of a high- and a low-intensity smoking cessation intervention in Sweden: a randomized trial.
abstract: STUDY OBJECTIVES To evaluate the cost-effectiveness of an additional 12-week treatment with varenicline for abstainers who had successfully completed an initial 12-week treatment . DESIGN The Benefits of Smoking Cessation on Outcomes simulation model was used to simulate both direct and indirect effects of smoking cessation . All calculations were performed in 2003 Swedish prices . SETTING Sweden in 2003 . PATIENTS OR PARTICIPANTS The modelled cohort consisted of 25 % of adult smokers motivated to quit smoking ( 168,844 males and 208,737 females ) . The age and sex distributions of the cohort reflect that of the Swedish population in 2003 . INTERVENTIONS Smokers who had achieved abstinence for at least 7 days following 12-week open-label treatment with varenicline were r and omized to receive an additional 12-week treatment with either varenicline or placebo . MEASUREMENTS AND RESULTS The incremental costs per quality -adjusted life-year ( QALY ) gained , for abstainers who received an additional 12-week varenicline treatment compared with only 12 weeks , were Euro 7066 for men and Euro 7108 for women , over a 50-year time horizon . ( 1 Euro approximately equal to SEK 9.12 ) . These estimates excluded indirect effects on production and consumption of increased survival . The corresponding incremental costs per QALY including indirect effects were Euro 24,149 and Euro 24,436 , respectively . Sensitivity analysis indicated that the estimated cost-utility ratios are robust , but relatively sensitive to treatment efficiency and intervention costs . CONCLUSIONS An additional 12-week course of varenicline treatment , provided to abstainers after an initial 12-week treatment , produces relatively low incremental cost-utility ratios in the spectrum of life-saving medical treatments Background Smoking is the leading cause of preventable death in the US . While one in five individuals smoke , and 70 % of these indicate a desire to quit , < 5 % of unaided quit attempts succeed . Cessation aids can double or triple the odds of successfully quitting . Models of smoking-cessation behaviour can eluci date the implication s of individual abstinence patterns to allow better tailoring of quit attempts to an individual ’s characteristics . Objective The objectives of this study were to develop and vali date a discrete-event simulation ( DES ) to evaluate the benefits of smoking abstinence using data from the pooled pivotal clinical trials of varenicline versus bupropion or placebo for smoking cessation and to provide a foundation for the development of a lifetime smoking-cessation model . Methods The DES model simulated the outcome of a single smoking-cessation attempt over 1 year , in accordance with the clinical trial timeframes . Pharmaceutical costs were assessed from the perspective of a healthcare payer . The model r and omly sample d patient profiles from the pooled varenicline clinical trials . All patients were physically and mentally healthy adult smokers who were motivated to quit abruptly . The model allowed for comparisons of up to five distinct treatment approaches for smoking cessation . In the current analyses , three interventions corresponding to the clinical trials were evaluated , which included brief counselling plus varenicline 1.0 mg twice daily ( bid ) or bupropion SR 150 mg bid versus placebo ( i.e. brief counselling only ) . The treatment periods in the clinical trials were 12 weeks ( target quit date : day 8) , with a 40-week non-treatment follow-up , and counselling continuing over the entire 52-week period in all treatment groups . The main outcome modelled was the continuous abstinence rate ( CAR ; defined as complete abstinence from smoking and confirmed by exhaled carbon monoxide ≤10 ppm ) at end of treatment ( weeks 9–12 ) and long-term follow-up ( weeks 9–52 ) , and total time abstinent from smoking over the course of 52 weeks . The model also evaluated costs and cost-effectiveness outcomes . Results For the varenicline , bupropion and placebo cohorts , respectively , the model predicted CARs for weeks 9–12 of 44.3 % , 30.4 % and 18.6 % compared with observed rates of 44.0 % , 29.7 % and 17.7 % ; over weeks 9–52 , predicted CARs in the model compared with observed rates in the pooled clinical studies were 22.9 % , 16.4 % and 9.4 % versus 22.4 % , 15.4 % and 9.3 % , respectively . Total mean abstinence times accrued in the model varenicline , bupropion and placebo groups , respectively , were 3.6 , 2.6 and 1.5 months and total pharmaceutical treatment costs were $ US261 , $ US442 and $ US0 ( year 2008 values ) over the 1-year model period . Using cost per abstinent-month achieved as a measure of cost effectiveness , varenicline dominated bupropion and yielded an incremental cost-effectiveness ratio of $ US124 compared with placebo . Conclusion The model accurately replicated abstinence patterns observed in the clinical trial data using individualized predictions and indicated that varenicline was more effective and may be less costly than bupropion . This simulation incorporated individual predictions of abstinence and relapse , and provides a framework for lifetime modelling that considers multiple quit attempts over time in diverse patient population s using a variety of quit attempt strategies The cost-effectiveness of  smoking cessation interventions is well documented . However , most studies are based on r and omized controlled trials ( RCTs ) and provide little information on the differences between subgroups . This study assessed the relative cost-effectiveness of smoking cessation interventions  offered to various subgroups of smokers , based on real-life data . Regression analyses provided information on the factors determining abstinence and costs and led to the formation of relevant subgroups of smokers . Probabilistic Markov modeling was then used to estimate the relative cost-effectiveness of smoking cessation interventions  for the entire data base population and for the subgroups compared to a no-intervention case . The ICER for the base case population was estimated at € 1,358 . This is consistent with results from the existing literature . Group simulations showed lower ICERs for men , hospitals , and light smokers and falling ICERs with increasing age . Despite differences in the cost-effectiveness ratios between subgroups our results do not justify any kind of subgroup differentiation in a smoking prevention policy BACKGROUND The aim of this study was to evaluate and compare the cost-effectiveness of varenicline with nicotine replacement therapy ( NRT ) for smoking cessation in four European countries ( Belgium , France , Sweden and the UK ) . METHODS Markov simulations , using the Benefits of Smoking Cessation on Outcomes ( BENESCO ) model , were performed . We simulated the incidence of four smoking-related morbidities : lung cancer , chronic obstructive pulmonary disease , coronary heart disease and stroke . The model computes quality -adjusted life-years gained and incremental cost-effectiveness ratios . Incremental cost-utility ratios were calculated , adopting a lifetime perspective . Efficacy data were obtained from a r and omized open-label trial : Week 52 continuous abstinence rates were 26.1 % for varenicline and 20.3 % for NRT . RESULTS The analyses imply that for countries analysed , smoking cessation using varenicline versus NRT was associated with reduced smoking-related morbidity and mortality . The number of morbidities avoided , per 1000 smokers attempting to quit , ranged from 9.7 in Belgium to 6.5 in the UK . The number of quality -adjusted life-years gained , per 1000 smokers , was 23 ( Belgium ) ; 19.5 ( France ) ; 29.9 ( Sweden ) ; and 23.7 ( UK ) . In all base-case simulations ( except France ) , varenicline dominated ( more effective and cost saving ) NRT regarding costs per quality -adjusted life-year gained ; for France the incremental cost-effectiveness ratio was 2803 . CONCLUSION This cost-effectiveness analysis demonstrated that since varenicline treatment was more effective , the result was increased healthcare cost savings in Belgium , Sweden and the UK . Our results suggest that funding varenicline as a smoking cessation aid is justifiable from a healthcare re source allocation perspective Introduction : An employer-based cost-benefit analysis for varenicline versus bupropion was conducted using clinical outcomes from a recently published trial . Methods : A decision tree model was developed based on the net benefit of treatment to produce a nonsmoker at 1 year . Sensitivity analyses were conducted based on quit rates with placebo and varenicline and the cost of varenicline . Results : Estimated 12-month employer cost savings per non-smoking employee were $ 540.60 for varenicline , $ 269.80 for bupropion SR generic , $ 150.80 for bupropion SR br and , and $ 81.80 for placebo . Varenicline was more cost beneficial  than placebo , which had quit rates of 16.9 % or less . The quit rate  with varenicline would have to be ≤16.9 % to lose cost benefit over bupropion SR generic . Conclusions : The economic benefit  of varenicline is improved over bupropion , despite the increased initial cost of varenicline Background  Physician training in smoking cessation counseling  has been shown to be effective as a means to increase quit success . We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme . Its effectiveness was previously demonstrated in a cluster r and omized , control trial performed in two Swiss university out patients clinics , in which residents were r and omized to receive training in smoking interventions or a control educational intervention .  Design and methods We used a Markov simulation model for effectiveness analysis . This model incorporates the intervention efficacy , the natural quit rate , and the lifetime probability of relapse after 1-year abstinence . We used previously published results in addition to hospital service and outpatient clinic cost data . The time horizon was 1 year , and we opted for a third-party payer perspective . Results The incremental cost of the intervention amounted to US$ 2.58 per consultation by a smoker , translating into a cost per life-year saved of US$ 25.4 for men and 35.2 for women . One-way sensitivity analyses yielded a range of US$ 4.0 - 107.1 in men and US$ 9.7 - 148.6 in women . Variations in the quit rate of the control intervention , the length of training effectiveness , and the discount rate yielded moderately large effects on the outcome . Variations in the natural cessation rate , the lifetime probability of relapse , the cost of physician training , the counseling time , the cost per hour of physician time , and the cost of the booklets had little effect on the cost-effectiveness ratio . Conclusions Training residents in smoking cessation counseling  is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions Abstract Objectives : To conduct a cost-utility analysis of two 12-week  smoking-cessation interventions in Japan :  smoking-cessation counselling by a physician compared with use of varenicline , an oral smoking-cessation drug , in addition to counselling . Methods : A Markov model was constructed to analyse lifetimemedical costs and QALYs from the perspective of the healthcare payer . The cycle length was 5 years . Both costs and QALYs were discounted at 3 % annually . The cohort of smokers was classified by sex and age , and we assumed that smokers started smoking at the age of 20 years and received smoking-cessation therapy at the ages of 30 , 40 , 50 , 60 or 70 years ( five separate models were run ) . The healthcare costs and QALYs were calculated throughout the term until the age of 90 years . In the base-case analysis , success rates of varenicline plus counselling and counselling alone were assumed to be 37.9 % and 25.5 % , respectively , in male smokers , and 22.2 % and 16.1 % , respectively , in female smokers , based on a r and omized controlled trial conducted in Japan . Both univariate and probabilistic sensitivity analyses were conducted . Results : Prescribed varenicline was shown to be more effective and less costly than smoking-cessation counselling alone . Varenicline would save direct medical costs of Japanese Yen (¥)43 846 ( $ US381 ; $ US1= ¥ 115 ; Oct 2007 ) and generate an increase of 0.094 QALYs in male smokers . In females the incremental costeffectiveness ratio was ¥ 346 143 per QALY gained . Varenicline is estimated to save ¥ 23.7 billion ( $ US206 million ) of the medical costs for tobacco-associated diseases for the whole population . Overall savings are ¥ 9.5 billion . Sensitivity analyses suggested the robustness of the results . Conclusion : As with any data of this nature , there is some uncertainty in the results and further research is warranted . However , based on the results of this pharmacoeconomic evaluation , varenicline , the first non-nicotine , oral treatment developed for smoking cessation , appears to be cost effective and may contribute to future medical cost savings in Japan BACKGROUND The 1998 UK government White Paper Smoking Kills emphasises that normal practice should be for general practitioners ( GPs ) , practice nurses , and others to offer advice and support to smokers in their efforts to stop . However , GPs are not allowed to write NHS prescriptions for nicotine-replacement therapy , even though this is the only effective pharmaceutical treatment available in the UK . We estimated the cost-effectiveness , for the NHS , of allowing GPs to prescribe transdermal nicotine patches for up to 12 weeks . METHODS We used data from a r and omised , placebo-controlled efficacy trial of nicotine patches and a survey of associated re source use in 30 GP surgeries in 15 English counties . We calculated the health benefit of nicotine-patch treatment in number of life years that would be saved by stopping smoking at various ages , and used an abstinence-contingent treatment model to calculate the incremental cost per life year saved by GP counselling with nicotine-patch treatment over GP counselling alone .  Cost effectiveness was assessed on the basis that GPs would provide repeat NHS prescriptions for up to 12 weeks if the treatment was proving successful . FINDINGS If GPs were allowed to prescribe transdermal nicotine patches on the NHS , for up to 12 weeks , the incremental cost per life year saved would be : Pound Sterling 398 per person younger than 35 years ; Pound Sterling 345 for those aged 35 - 44 years ; Pound Sterling 432 for those aged 45 - 54 years ; and Pound Sterling 785 for those aged 55 - 65 years . INTERPRETATION The low cost per life year saved would make GP intervention against smoking a cost-effective life-saving treatment . The priniciples of the government White Paper could be cost-effectively extended into general practice to reduce smoking and smoking-related illnesses BACKGROUND Smoking cessation can be encouraged by reimbursing the costs of smoking cessation support ( SCS ) . The short-term efficiency of reimbursement has been evaluated previously . However , a thorough estimate of the long-term cost-utility is lacking . OBJECTIVES To evaluate long-term effects of reimbursement of SCS . METHODS Results from a r and omized controlled trial were extrapolated to long-term outcomes in terms of health care costs and ( quality adjusted ) life years ( QALY ) gained , using the Chronic Disease Model . Our first scenario was no reimbursement . In a second scenario , the short-term cessation rates from the trial were extrapolated directly . Sensitivity analyses were based on the trial 's confidence intervals . In the third scenario the additional use of SCS as found in the trial was combined with cessation rates from international meta-analyses . RESULTS Intervention costs per QALY gained compared to the reference scenario were approximately euro1200 extrapolating the trial effects directly , and euro4200 when combining the trial 's use of SCS with the cessation rates from the literature . Taking all health care effects into account , even costs in life years gained , result ed in an estimated incremental cost-utility of euro4500 and euro7400 , respectively . In both scenarios costs per QALY remained below euro16 000 in sensitivity analyses using a life-time horizon . CONCLUSIONS Extrapolating the higher use of SCS due to reimbursement led to more successful quitters and a gain in life years and QALYs . Accounting for overheads , administration costs and the costs of SCS , these health gains could be obtained at relatively low cost , even when including costs in life years gained . Hence , reimbursement of SCS seems to be cost-effective from a health care perspective Abstract Background and Objective : Varenicline is a nicotinic acetylcholine receptor partial agonist that is approved for use as an aid to smoking cessation . R and omized clinical trials show that its efficacy is superior to that of other current smoking cessation therapies . This study set out to determine the cost effectiveness of varenicline relative to other smoking cessation interventions ( bupropion and nicotine replacement therapy [ NRT ] ) as well as brief counselling alone and unaided cessation in a cohort of Belgian adult smokers making a one-time quit attempt , from the perspective of the healthcare payer ( public and private ) . Methods : A Markov model , the Benefits of Smoking Cessation on Outcomes ( BENESCO ) model , was applied to calculate the long-term health and economic benefits of smoking cessation . Cost effectiveness was expressed as cost per life-year ( LY ) gained and cost per quality -adjusted life-year ( QALY ) gained . Clinical and economic model inputs were obtained from the literature and public healthcare data bases . Costs were discounted at 3 % and health outcomes at 1.5 % . A probabilistic sensitivity analysis and a one-way sensitivity analysis were performed to test the robustness of the results . Results : Varenicline is associated with a reduction of smoking-related morbidity and mortality as well as with a decrease in healthcare costs compared with the pharmacological agents bupropion and NRT . Varenicline also leads to additional LYs and QALYs compared with brief counselling alone and unaided cessation over a lifetime period . Varenicline is a dominant strategy compared with bupropion and NRT . Compared with brief counselling alone and unaided cessation , varenicline presents a cost/QALY of € 240 and € 1656 , respectively . Conclusion : Varenicline is a cost-effective alternative to brief counselling and unaided cessation , and is a cost-saving treatment in comparison with bupropion and NRT , in a Belgian population of smokers willing to quit OBJECTIVE To assess the relative cost-effectiveness of a high-intensity treatment ( HIT ) and a low-intensity treatment ( LIT ) for smoking cessation . METHODS The societal and health care perspective economic evaluation was based on the reported number of quitters at 12-month follow-up ( point prevalence ) from a r and omized controlled trial of 2 smoking cessation programs in Sweden . Future disease-related costs ( in Swedish kronor [ SEK ] 2004 ; SEK7.35 = USD1 ) and health effects ( in quality -adjusted life-years [ QALYs ] ) were estimated via a Markov model comprising lung cancer , chronic obstructive pulmonary disease , and cardiovascular disease including stroke with costs and QALYs discounted 3 % annually . RESULTS HIT was more effective than LIT ( 23 % vs. 16 % quitters ) , but at a considerably higher intervention cost : SEK26,100 versus 9,100 per quitter . The model-estimated societal costs avoided did not balance the higher intervention costs , so the incremental cost-effectiveness ratio ( ICER ) amounted to SEK100,000 per QALY for HIT versus LIT . All sensitivity analyses indicated an ICER below SEK300,000 and that HIT is the preferred option if the decision maker willingness-to-pay exceeds SEK50,000 per QALY . Compared with no intervention , LIT was cost saving , whereas HIT was estimated at SEK8,400 per QALY . CONCLUSIONS Compared with no smoking cessation program , it is a societal waste not to implement the LIT as it is estimated to result in lower societal costs . The incremental cost per QALY gained of SEK100,000 for HIT is considered very cost-effective in Sweden . Thus , if smoking cessation programs are judged in the same manner as other Swedish health care measures , the high-intensity program should be chosen before the low-cost program
target: All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context
background: AIMS To identify different types of models used in economic evaluations of smoking cessation , analyse the quality of the included models examining their attributes and ascertain their transferability to a new context .