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.
Key words
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Article info
Publication history
Published online: July 23, 2012
Accepted:
July 5,
2012
Identification
Copyright
© 2012 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
