The European Journal of Public Health Advance Access published online on June 2, 2009
The European Journal of Public Health, doi:10.1093/eurpub/ckp075
Cost-effectiveness of varenicline compared with nicotine patches for smoking cessation—results from four European countries
Kristian Bolin1, Koo Wilson2, Hicham Benhaddi3, Enrico de Nigris2, Sophie Marbaix4, Ann-Christin Mork5 and Henri-Jean Aubin6
1 Lund University Department of Economics and Centre for Health Economics, Lund, Sweden
2 Pfizer Ltd, Walton Oaks, Surrey, UK
3 Pfizer France, Paris, Cédex 14, France
4 Pfizer, Brussels, Belgium
5 Pfizer AB, Sollentuna, Sweden
6 Centre d’Addictologie, Hôpital Paul-Brousse, AP-HP, France
Correspondence: Kristian Bolin, Department of Economics, Lund University, P.O. Box 7082, SE-220 07 Lund, Sweden, tel: +46 46 222 8655, fax: +46 46 222 4118, e-mail: kristian.bolin{at}nek.lu.se
Received November 26, 2008 , accepted May 8, 2009
Background: The aim of this study was to evaluate and compare the cost-effectiveness of varenicline with nicotine replacement therapy (NRT) for smoking cessation in four European countries (Belgium, France, Sweden and the UK). Methods: Markov simulations, using the Benefits of Smoking Cessation on Outcomes (BENESCO) model, were performed. We simulated the incidence of four smoking-related morbidities: lung cancer, chronic obstructive pulmonary disease, coronary heart disease and stroke. The model computes quality-adjusted life-years gained and incremental cost-effectiveness ratios. Incremental cost-utility ratios were calculated, adopting a lifetime perspective. Efficacy data were obtained from a randomized open-label trial: Week 52 continuous abstinence rates were 26.1% for varenicline and 20.3% for NRT. Results: The analyses imply that for countries analysed, smoking cessation using varenicline versus NRT was associated with reduced smoking-related morbidity and mortality. The number of morbidities avoided, per 1000 smokers attempting to quit, ranged from 9.7 in Belgium to 6.5 in the UK. The number of quality-adjusted life-years gained, per 1000 smokers, was 23 (Belgium); 19.5 (France); 29.9 (Sweden); and 23.7 (UK). In all base-case simulations (except France), varenicline dominated (more effective and cost saving) NRT regarding costs per quality-adjusted life-year gained; for France the incremental cost-effectiveness ratio was 2803. Conclusion: This cost-effectiveness analysis demonstrated that since varenicline treatment was more effective, the result was increased healthcare cost savings in Belgium, Sweden and the UK. Our results suggest that funding varenicline as a smoking cessation aid is justifiable from a healthcare resource allocation perspective.
Keywords: cost-effectiveness, nicotine replacement therapy, smoking cessation, varenicline.