Budgetary impact analysis on funding smoking-cessation drugs in patients with COPD in Spain

Figures & data

Figure 1 Diagram of the model: epidemiological cohort and Markov chain.

Abbreviations: COPD, chronic obstructive pulmonary disease; NRT, nicotine replacement therapy.

Table 1 Unit costs (in €, 2014)

Parameter	Cost (in €, 2014)
Smoking-cessation drugs	MSP–VATa,^Citation27	RRP–VATa,^Citation27
Cost of treatment considering dose, duration, and compliance as observed in the clinical trials^Citation33–Citation35
Varenicline	€159.30	€248.67
Bupropion	€108.33	€169.11
Nicotine replacement therapy	€152.50	€238.06
Medical visits	Unit cost^Citation40,Citation41
Initial visit with specialist	€130
Follow-up visit with specialist	€78
Visit with nursing personnel	€18
Yearly economic benefits in terms of health care resources avoided in patients who quit smoking by year of cessationb,^Citation10
	40–69 years	≥70 years
First year	€0	€0
Second year	€770 (95% CI: 90–1,531)	€1,398 (95% CI: 961–1,836)
Third year	€1,089 (95% CI: 361–1,727)	€1,977 (95% CI: 1,341–2,644)
Fourth year	€1,567 (95% CI: 1,079–2,024)	€2,258 (95% CI: 1,877–2,691)
Fifth year	€1,871 (95% CI: 1,435–2,328)	€2,356 (95% CI: 1,889–2,773)

Notes:

a Required deduction of 7.5% included as per RD 8/2010.

b Avoided costs are referred to as COPD-specific drugs, oxygen therapy, primary care medical visits, specialist medical visit, and emergency visit, hospital admissions due to COPD exacerbations of cardiovascular events, diagnostic procedures, and laboratory tests.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; MSP–VAT, manufacturing selling price–value added tax; RD, Royal decree; RRP–VAT, recommended retailing price–value added tax.

Table 2 Estimation flow of patients that should be treated with smoking cessation therapies yearly in Spain in funded and in unfunded scenarios

Variable	Unfunded scenario					Funded scenario
	Year 1	Year 2	Year 3	Year 4	Year 5	Year 1	Year 2	Year 3	Year 4	Year 5
General population ≥40 years	24,321,996					24,321,996
Prevalent population with COPD	1,913,441					1,913,441
Incident population with COPD		222,000	224,888	227,680	230,289		222,000	224,888	227,680	230,289
Population diagnosed with COPD	516,629	59,940	60,720	61,474	62,176	568,292	65,934	66,792	67,621	68,396
Population of smokers diagnosed with COPD	100,606	14,895	15,072	15,238	15,388	110,666	16,385	16,579	16,762	16,927
Population of smokers with COPD who want	61,369	9,086	9,194	9,295	9,387	101,260	14,992	15,170	15,337	14,488
to quit smoking
Population of smokers with COPD with at	26,266	3,889	3,935	3,978	4,018	43,339	6,417	6,493	6,564	6,629
least one attempt to stop smoking
Total number of COPD patients who want	3,638	539	545	551	556	26,740	3,959	4,006	4,050	4,090
to stop smoking with the aid of drug treatment
With varenicline	797					11,926
With bupropion	913					1,123
With NRT	1,928					13,691
Accumulated failures		3,358	3,605	3,849	1,421		22,493	22,375	22,431	8,904
Relapses after abstaining for 52 weeks		8	17	26	28		127	250	368	368
Total number of patients treated yearly	3,638	3,905	4,167	4,426	2,006	26,470	26,579	26,630	26,850	13,361
Total number of patients who stop smoking yearly	280	300	319	338	154	4,247	4,205	4,199	4,222	2,111
With varenicline	81	85	89	93	43	2,218	2,146	2,104	2,083	1,071
With bupropion	50	55	60	64	28	112	118	124	129	60
With NRT	148	159	170	180	82	1,917	1,940	1,972	2,010	980

Abbreviations: COPD, chronic obstructive pulmonary disease; NRT, nicotine replacement therapy.

Table 3 Results of the budget-impact analysis for the Spanish National Health System, by year and accumulated cost

Variable		Year 1	Year 2	Year 3	Year 4	Year 5	Accumulated
Cost in smoking-cessation drugs (in millions of €)	Without funding	0	0	0	0	0	0
	With funding	4.109	4.080	4.083	4.114	2.500	18.436
Health care costs (in millions of €)	Without funding	0	0	0	0	0	0
	With funding	4.929	4.861	4.838	4.848	2.438	21.914
Mean costs incurred (in millions of €)	Without funding	0	0	0	0	0	0
	With funding	9.038	8.941	8.921	8.962	4.488	40.350
Mean costs avoided by stopping smoking (in millions, €)	Without funding	0	270	653	1.145	1.316	3.384
	With funding	0	4.096	9.573	16.319	18.005	47.992
Budgetary impact (in millions, €) for National Health System due to effect of funding vs no funding		9.038	5.115	708	−6.212	−12.201	−4.258

Table 4 Results of the budget-impact analysis (in millions of €), by year and accumulated cost, in the autonomous community-funded scenario with smoking-cessation drugs

Autonomous community	Year 1	Year 2	Year 3	Year 4	Year 5	Accumulated
Andalusia	1.531	866	120	−1.052	−2.067	−721
Aragon	273	154	21	−187	−368	−128
Asturias	241	136	19	−165	−325	−113
Balearic Islands	201	114	16	−138	−272	−95
Cantabria	122	69	10	−84	−165	−58
Canary Islands	393	222	31	−270	−530	−185
Castilla-La Mancha	393	222	31	−270	−530	−185
Castile and León	551	312	43	−379	−744	−260
Catalonia	1.428	808	112	−982	−1.928	−673
Ceuta and Melilla	25	14	2	−17	−35	−12
Extremadura	218	123	17	−150	−295	−103
Galicia	597	338	47	−410	−806	−281
Madrid	1.197	678	94	−823	−1.616	−564
Murcia	254	144	20	−175	−343	−120
Navarre	125	71	10	−86	−169	−59
Basque country	460	260	36	−316	−621	−217
La Rioja	63	36	5	−44	−86	−30
Valencia	964	546	76	−663	−1.302	−454

Figure 2 Results of the budget impact for the sensitivity analysis.

Notes: The values (in millions of €) of the different scenarios show the impact of the current funded scenario compared with the current unfunded scenario. BIA, budget-impact analysis. The values (in millions of €) of the different scenarios show the impact of this scenario on the current unfunded scenario after discarding the value observed in the current scenario.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 3 Tornado chart showing the results of the accumulated budgetary impact after the 5-year sensitivity analysis.

Note: The values (in millions of €) indicate the differences between the funded and unfunded scenarios.
Abbreviation: COPD, chronic obstructive pulmonary disease.

Drug Catalogue of the Consejo General de Colegios de Farmacéuticos. Bot Plus Web2013Drug Catalogue of the General Council of Official Colleges of Pharmacists Available from: http://www.portalfarma.comAccessed September 27, 2013

 Google Scholar

SongFRafteryJAveyardPHydeCBartonPWoolacottNCost-effectiveness of pharmacological interventions for smoking cessation: a literature review and a decision analytic analysisMed Decis Making2002225 supplS26S3712369228

 PubMed Web of Science ®Google Scholar

AntoñanzasFPortilloFEvaluación económica del empleo de terapias farmacológicas para la cesación en el hábito tabáquico [Economic evaluation of pharmacotherapies for smoking cessation]Gac Sanit20031739340314599422

 PubMedGoogle Scholar

Tarifas de asistencia sanitaria ambulatoria de la Comunidad de Madrid (B.O.C.M. 215 de 10 de septiembre de 2013)Tariffs of healthy outpatient resources of Autonomous Community of Madrid2013 Available from: http://w3.bocm.es/boletin/CM_Orden_BOCM/2013/09/10/BOCM-20130910-1.PDFAccessed September 27, 2013

 Google Scholar

Guía de deshabituación tabáquica del Instituto Catalán de la Salud2013Guideline for smoking cessation of the Catalonia Institute of Health Available from: http://www.ics.gencat.cat/3clics/main.php?page=GuiaPage&idGuia=1&lang=CASAccessed September 27, 2013

 Google Scholar

Sicras-MainarARejas-GutiérrezJNavarro-ArtiedaRIbañez-NollaJThe effect of quitting smoking on costs and healthcare utilization in patients with chronic obstructive pulmonary disease: a comparison of current smokers versus ex-smokers in routine clinical practiceLung201419250551824816902

 PubMed Web of Science ®Google Scholar