Cost effectiveness of retreatment with varenicline compared to other commonly used smoking cessation interventions

Abstract

One quit attempt with varenicline has been found to be a cost saving smoking cessation (SC) intervention. However, success in quitting smoking may need more than one quit attempt. The purpose of this study was to extend the previous cost effectiveness analysis to two quit attempts. Comparison was made between retreatment schema with varenicline and one with bupropion, NRT and unaided cessation, and treatment once with varenicline in a Finnish context. The two-quit model of Benefits of Smoking Cessation on Outcomes(BENESCO) Markov model was used to follow a hypothetical cohort of smokers making up to two quit attempts. Gender and age-specific data on the incidence and prevalence of five smoking-related diseases were included into the model. Quality-adjusted life-years, total expected costs and the lifetime cumulative incidence of smoking-related morbidities and mortality were the primary outcomes evaluated. Probabilistic sensitivity analysis was performed to test the robustness of the base case model. The study cohort comprised 116,533 smokers who were willing to make a quit attempt. Retreatment with varenicline yielded 6,150–20,250 extra quitters depending on the comparator. Among these quitters it was possible to prevent 899–2,972 additional cases of smoking-related diseases and 395–1,307 deaths attributable to smoking. Retreatment with varenicline resulted in cost savings of up to 54.9 million euros. By being more effective and less costly, retreatment with varenicline dominated all the other SC interventions. Sensitivity analysis supported the robustness of the base case results. A second quitting effort with varenicline is economically justifiable.