A systematic review of quality and cost–effectiveness derived from Markov models evaluating smoking cessation interventions in patients with chronic obstructive pulmonary disease

Abstract

Smoking cessation is the only strategy that has shown a lasting reduction in the decline of lung function in patients with chronic obstructive pulmonary disease. This study aims to evaluate the cost-effectiveness of smoking cessation interventions in patients with chronic obstructive pulmonary disease, to assess the quality of the Markov models and to estimate the consequences of model structure and input data on cost–effectiveness. A systematic literature search was conducted in PubMed, Embase, BusinessSourceComplete and Econlit on June 11, 2014. Data were extracted, and costs were inflated. Model quality was evaluated by a quality appraisal, and results were interpreted. Ten studies met the inclusion criteria. The results varied widely from cost savings to additional costs of €17,004 per quality adjusted life year. The models scored best in the category structure, followed by data and consistency. The quality of the models seems to rise over time, and regarding the results there is no economic reason to refuse the reimbursement of any smoking cessation intervention.

Keywords:

• chronic obstructive pulmonary disease
• cost–effectiveness
• Markov model
• review
• smoking cessation

Acknowledgements

The author would like to thank C Becker, who independently undertook the literature review for validation.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Chronic obstructive pulmonary disease (COPD) is a chronic condition with severe consequences and is a major public health problem.

• Smoking cessation is the only strategy that has shown a lasting reduction in the decline of lung function in patients with COPD.

• A number of Markov models have been used in recent years to estimate the cost–effectiveness of smoking cessation interventions in patients with COPD.

• To date, no systematic review comparing Markov models evaluating smoking cessation in patients with COPD and their results exists.

• The structures of all models, except for two of 10, seem adequate to reflect disease progression for COPD. The imputed data for the models vary most for cost-of-illness of COPD, abstinence rate of smoking cessation intervention and intervention costs, but least for health-related quality of life.

• With regard to the quality of the models, the newer models seem to perform better; at least regarding the more sophisticated sensitivity analyses and the more complex model structure (considering exacerbations).The overall percentage score for all models is best for structure, followed by data and consistency.

• The results range from cost savings to additional costs of €17,004 per quality adjusted life year, the robustness of the results is confirmed by univariate and probabilistic sensitivity analyses.

• Despite the uncertainty about which intervention has the best cost–effectiveness ratio, there is no economic reason for health insurers to refuse the reimbursement of any smoking cessation intervention.

Notes