Budgetary impact analysis on funding smoking-cessation drugs in patients with COPD in Spain

Abstract

The aim of the study was to assess the budgetary impact of funding smoking-cessation drugs in COPD patients in Spain. A hybrid model (cohort and Markov) was developed for a 5-year time horizon. Only approved cessation drugs (varenicline, bupropion, and nicotine replacement therapy) were considered. Irrespective of the drug, the model allowed for an initial cessation attempt, and up to three additional attempts in case of failure or smoking relapse during a 5-year period. Drug effectiveness was based on controlled clinical trials. National Health System perspective was applied; therefore, only medical resources were included. The pharmaceutical costs for smoking-cessation drugs, extra medical follow-up as a consequence of public reimbursement, and annual savings for health costs avoided due to stopping smoking were considered. The model estimated that 17,756 COPD patients would stop smoking if public funding was available, compared with 1,303 without reimbursement. In the reimbursement scenario, the savings accounted for a total of €48.0 million, compensating for expenditures on drugs and medical visits (€40.4 million). Accumulated total additional savings in 5 years (€4.3 million) compared with the scenario without reimbursement was shown. Sensitivity analyses supported the results robustness. Funding smoking-cessation drugs in COPD patients seems to be an efficient option and a National Health System drug reimbursement scheme would represent a cost-saving policy in Spain.

Cost‐effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD

“…Moreover, three main pharmacological options could be implemented: nicotine replacement therapy (NRT) in various forms (gum or patch), bupropion and varenicline. These interventions are cost‐effective strategies 14, 15, 16 but are not covered currently by the Spanish National Health Service (NHS) or the coverage is limited to certain groups (health‐care workers or people with limited resources). According to the World Health Organization 17, Spain has national smoke‐free legislation; a tobacco taxation policy; complete bans on tobacco advertising, promotion and sponsorship; services to treat tobacco dependence; and requirements to put health warnings on tobacco packages.…”

Factors associated with current smoking in COPD patients

“…Patients should be supported in their quit attempts not only with motivational counselling but also with changes in tobacco control policies, such as covering smoking cessation interventions and approved SC medications under health insurance, as recommended in a previous guidance 28 . COPD patients demonstrate proven cost-effectiveness of free SC interventions, and they need support to overcome nicotine withdrawal symptoms and other challenges is smoking cessation [29][30][31] .…”

Varenicline treatment for smoking cessation in high risk patients: a budget impact analysis

“…The Budget Impact deriving from the access to reimbursement of smoking cessation drugs, and in particular varenicline, was repeatedly analyzed: Taylor et al [33] demonstrated the economic benefits deriving from the reimbursement of varenicline in the perspective of the UK NHS; in Spain Jiménez-Ruiz et al [5] came to the same conclusions for COPD patients over a 5-year time horizon. Cedillo et al [7] -considering as target population smokers with COPD, t2-DM or CVD, who represent a high-risk population both in terms of health and healthcare resources -estimate that varenicline reimbursement would be cost-saving from the third year.…”

“…The WHO also estimates that about half of regular smokers are destined to die prematurely, due to tobacco consumption [1], and similar values also emerge from studies conducted on individual Countries [2]. Tobacco consumption increases the risk of cardiovascular (CVD) [3,4] and bronchopulmonary diseases (COPD -chronic obstructive pulmonary disease) [5,6], as well as being the main cause of some types of cancer. It is also a risk factor for several chronic conditions, including type 2 diabetes [7].…”