Re-treatment with varenicline is a cost-effective aid for smoking cessation

Figures & data

Table 1. Baseline information of the study population.

	Current smoker (%)^a	Former smoker (%)^a	Never smoker (%)^a	Current smokers making a quit attempt (%)^b	Utility^c
Males 18–34 years	18.3	28.7	53.0	24.6	0.96
Males 35–64 years	20.3	33.4	46.4	17.2	0.94
Males 65+ years	11.7	44.6	43.7	17.2	0.87
Females 18–34 years	13.4	25.5	61.1	12.1	0.95
Females 35–64 years	14.9	24.2	60.9	16.7	0.93
Females 65+ years	6.9	17.8	75.3	16.7	0.88

^a Figures from Borodulin et al.¹².

^b Figures for age groups 18–34 and 35–64 from Helldán et al.¹³; for age group 65+ no information and, hence, assumed to be the same as in the age group 35–64.

^c Figures from Koskinen et al.¹⁴.

Figure 1. Structure of the re-treatment model.

Table 2. Cost estimates (€) used in the model.

	1st year	Subsequent years	Source
Treatment cost of lung cancer	13,473	1,824	Descriptions of treatment practices from medical experts and literature (e.g. current care guidelines); unit costs from Kapiainen et al.^30, Finnish version of NordDRGs, Pharmaceuticals Pricing Board (PPB)
Treatment cost of COPD	1,423	1,423
Treatment cost of CHD	11,657	3,668
Treatment cost of stroke	21,303	14,429
Treatment cost of asthma exacerbation	2,044		Finnish version of NordDRGs, weighted average of DRG groups 96 and 97^a (asthma, adults, w and w/o cc)
Smoking cessation intervention	Cost/intervention
Varenicline (Champix)	379.04		12 weeks treatment +1 GP visit; PPB (medicine costs), Kapiainen et al.^30 (GP visit)
Bupropion (Zyban)	369.29
Nicotine replacement therapy	209.32		12 weeks treatment +1 GP visit;
Unaided cessation	0

^a Available at http://www.norddrg.fi/content/painokertoimet-2013.

Table 3. Numbers of smoking-related morbidities and mortalities avoided if using 2QA varenicline instead of other CS interventions.

Disease	2QA Bupropion		2QA NRT		2QA Unaided		1QA Varenicline
	Cases Deaths		Cases Deaths		CasesDeaths		Cases Deaths
COPD	248	16	291	19	819	54	392	26
Lung cancer	275	254	324	299	909	839	435	402
ACS	156	51	184	60	517	169	247	81
Stroke	220	74	258	87	727	245	346	117
Total	899	395	1,057	465	2,972	1,307	1,420	626

Table 4. The incremental costs, effectiveness, and cost effectiveness ratios (ICER) of SC intervention 2QA Varenicline compared to the other SC interventions (incremental costs represent the additional costs, and incremental QALYs the lower effectiveness, compared to 2QA Varenicline).

SC intervention	Costs (millions €)	QALYs	Incremental costs (millions €)	Incremental QALYs	ICER
2QA Varenicline	2,605	1,835,400
2QA Bupropion	2,645	1,831,805	+40.1	−3,595	dominated^a
2QA NRT	2,618	1,831,175	+12.7	−4,225	dominated^a
2QA Unaided	2,660	1,823,452	+54.9	−11,948	dominated^a
1QA Varenicline	2,633	1,829,742	+27.6	−5,658	dominated^a

^a An intervention is dominated when its costs are higher and effectiveness lower compared to the comparator intervention.

All the figures are presented at population level.

Figure 2. Scatter plot of probabilistic sensitivity analysis: 2QA Varenicline vs 2QA NRT.

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