Budgetary Impact Analysis of Reimbursement Varenicline for the Smoking-Cessation Treatment in Patients with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease or Type-2 Diabetes Mellitus: A National Health System Perspective

• Published in: European addiction research 2017, Vol.23 (1), p.7-18
• Main Authors: Cedillo, Sergio, Sicras-Mainar, Antoni, Jiménez-Ruiz, Carlos A., de Bobadilla, Jaime Fernández, Rejas-Gutiérrez, Javier
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cardiovascular disease; Cardiovascular Diseases - economics; Cardiovascular Diseases - psychology; Chronic obstructive pulmonary disease; Cost-Benefit Analysis; Diabetes; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - psychology; Female; Health Care Costs - statistics & numerical data; Humans; Impact analysis; Insurance, Health, Reimbursement - economics; Male; Markov Chains; Middle Aged; Models, Economic; Prescription drugs; Pulmonary Disease, Chronic Obstructive - economics; Pulmonary Disease, Chronic Obstructive - psychology; Reimbursement; Research Report; Smoking cessation; Smoking Cessation - economics; Smoking Cessation - methods; Spain; Varenicline - economics
• ISSN: 1022-6877; 1421-9891
• DOI: 10.1159/000449098

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.