PRS19 COST-UTILITY OF VARENICLINE VERSUS INTERVENTIONS AVAILABLE FOR QUITTING SMOKING IN PANAMA USING THE BENESCO MODEL

Abstract

In Panama, between 13.5-16.5% of all deaths are associated to tobacco consumption. The Ministry of Health (MoH) determined that tobacco use is associated to seven of the leading causes of death in the country. The aim of this study was to estimate the incremental cost–utility ratios for varenicline compared to bupropion, nicotine replacement therapy (NRT) and unaided cessation for quitting smoking using a time-horizon of 20 years from an institutional perspective. The Benefits of Smoking Cessation on Outcomes(BENESCO) simulation model was used for an adult cohort of subjects (n=2,249,676). BENESCO model contains projected outcomes for cardiovascular diseases, chronic obstructive pulmonary disease, lung cancer and stroke. The smoking cessation therapies evaluated were: varenicline (0.5–2 mg/day) versus bupropion (300 mg/day), NRT (5-10 mg/day) and unaided cessation. Effectiveness and utility measures were collected from published literature. Unit costs and resource use used data was gathered from the Panama's MoH(2009). Costs (expressed in 2009US$) and health outcomes were discounted at 3%. Probabilistic sensitivity analyses (PSA) were conducted. Smoking cessation efficacy rates were: 22.5%; 15.7%; NRT 13.7% and 5.9% for varenicline, bupropion, NRT and unaided cessation, respectively. After 20 years, varenicline exhibited the highest number of QALYs gained (2,144,323) against bupropion (−1,717 QALYs); NRT (−2,222 QALYs) and unaided cessation (−4,191 QALYs). QALYs differences showed to be meaningful in the healthcare system. Costs showed varenicline is the least expensive alternative with US$311,795,928 less than NRT and US$240,956,600 less than bupropion. Varenicline dominated all smoking cessation strategies. PSA support previous findings. Acceptability curves showed that varenicline would be cost-effective within <3 GDP per capita threshold. Results suggest that varenicline would be the cost-saving treatment. In Panama, the government is responsible by law to develop smoking cessation programs, thus varenicline could be helpful to enhance cost-containment policies and improve Panama health-outcomes.