Cost-Effectiveness of Varenicline Versus Bupropion, Nicotine-Replacement Therapy, and Unaided Cessation in Greece

• Published in: Clinical therapeutics 2012-08, Vol.34 (8), p.1803-1814
• Main Authors: Athanasakis, Kostas, MSc, PhD, Igoumenidis, Michael, MA, PhD, Karampli, Eleftheria, MSc, Vitsou, Elli, MSc, Sykara, Georgia, PhD, Kyriopoulos, John, MD, MPH, MSc, PhD
• Format: Article
• Language: English
• Subjects: Benzazepines - economics; Benzazepines - therapeutic use; Biological and medical sciences; Bupropion - economics; Bupropion - therapeutic use; Cardiovascular disease; Computer Simulation; Cost Savings; Cost-Benefit Analysis; cost-effectiveness analysis; Drug Costs; Greece; Greece - epidemiology; Health Care Costs; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Insurance, Health, Reimbursement - economics; Internal Medicine; Markov Chains; Medical Education; Medical sciences; Models, Economic; Monte Carlo Method; Mortality; Nicotine; nicotine-replacement therapy; Pharmacology. Drug treatments; Prevalence; Quality-Adjusted Life Years; Quinoxalines - economics; Quinoxalines - therapeutic use; smoking; Smoking - economics; Smoking - mortality; Smoking cessation; Smoking Cessation - economics; Smoking Prevention; smoking-cessation aids; Studies; Time Factors; Tobacco Use Cessation Products - economics; Tobacco Use Disorder - economics; Tobacco Use Disorder - mortality; Tobacco Use Disorder - therapy; Tobacco, tobacco smoking; Toxicology; Treatment Outcome; Varenicline; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2012.07.002

Abstract Background Varenicline was designed to relieve symptoms of nicotine withdrawal, including cigarette craving, and to block the reinforcing effects of continued nicotine use. The cost-effectiveness of varenicline in some countries has not been studied. Objective The aim of this study was to compare the cost-effectiveness of varenicline to that of bupropion, nicotine-replacement therapy (NRT), and unaided cessation in the Greek health care setting. The analysis takes into account a societal security (third-party payer) perspective. Methods To perform the analyses of the benefits of smoking cessation in terms of smoking-related morbidity, mortality, and associated medical costs, a Markov model was used that simulated the progress of a hypothetical cohort of current smokers making a single attempt to quit smoking at the beginning of the timeframe of the analysis. The robustness of the results was assessed using a series of 1-way sensitivity analyses. Results Varenicline was associated with the potential prevention of 14.1, 14.2, and 35.1 additional cases of the 4 smoking-related diseases incorporated into the model, per 1000 smokers willing to quit, versus bupropion, NRT, and unaided cessation, respectively. Potentially avoided smoking-related deaths with varenicline were estimated at 3.24, 3.26, and 7.5 per 1000 quitters versus the 3 comparators. Varenicline led to a potential gain of 33.78, 33.91, and 83.97 QALYs per 1000 persons willing to make a quit attempt versus the 3 comparators. Varenicline was associated with cost-savings against both active comparators for the lifetime horizon. Overall, the cost per additional quitter with varenicline, considering only the costs of the smoking-cessation strategy, was €2659 (€1015) for a lifetime horizon compared with bupropion (NRT); however, when all direct costs were incorporated into the analysis, varenicline was cost-saving. Conclusion The findings from the present study suggest that, compared with the widely used treatment options bupropion and NRT, as well as unaided cessation, varenicline may enhance smoking-cessation treatment outcomes while substantially reducing the overall costs of smoking to the health care system.