PMH10 - Budgetary Impact Analysis of Reimbursement Varenicline in the Smoking Cessation Treatment of Patients with Major Depression in Spain

Abstract

Around 60.000 people die every year in Spain because of tobacco related diseases. Major depression and smoking seem to have a cause-effect relationshipbetween them. Varenicline is indicated for smoking cessation; however it is still not reimbursed in the Spanish National Health System (NHS) for such patients. The objective was to estimate the budgetary impact (BI) of funding varenicline by the NHS in patients with MD who wish quitting smoking. BI was estimated comparing the actual not-reimbursed versus a reimbursed scenario using the Spanish Societal and NHS perspectives. A hybrid model was designed with a decision tree algorithm to estimate size of populations and a Markov modelling simulating until four quitting attempts with varenicline during a 5-year horizon. Costs of cessation attempts were considered in the reimbursement scenario only, and included varenicline, medical visits and counselling. Varenicline efficacy (one-year of continuous abstinence rate) was derived from a clinical trial. Costs saving due to smoking cessation were extracted from the 2011/2012 National Health Survey. Results are showed as incremental costs of funding versus not funding varenicline. Univariate sensitivity analysis was also carried-out. Five-years cumulated cessation attempts increased from 26,696 in the not-reimbursed to 68,129 in the reimbursed scenario, yielding to 30,040 extra subjects quitting smoking. Cost of reimbursement varenicline was estimated to be €12.4 million (€4.1 million corresponding to the drug), while smoking cessation avoided costs would reach €27.3 million, which compared with €5.3 million savings in the not-reimbursed scenario: a net incremental cost-saving of €9.6 million. Results were robust through several alternative scenarios including that of the Spanish NHS. Reimbursement of varenicline in smoking cessation subjects with a major depressive disorder is an efficient health policy in Spain, both from the Society and NHS perspectives and could produce cost-savings since the 3rd year of implementation.