Cost-Utility Analysis of Varenicline, an Oral Smoking-Cessation Drug, in Japan

Igarashi, Ataru; Takuma, Hiroki; Fukuda, Takashi; Tsutani, Kiichiro

doi:10.2165/00019053-200927030-00007

Cited by 35 publications

(52 citation statements)

References 25 publications

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“…Several such treatments, bupropion and varenicline, are more costly than NRT and appear to display greater risks [30][31][32] . A logical, stepped-care approach would thus entail initial use of pre-cessation NRT, assignment of nicotine dose based on dependence level and quit-success genotype scores, identification of individuals who do not reduce CO sufficiently and prompt 18 .…”

Section: Discussionmentioning

confidence: 99%

Personalized Smoking Cessation: Interactions between Nicotine Dose, Dependence and Quit-Success Genotype Score

Rose

Behm

Drgon

et al. 2010

Mol Med

131

104

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Improving and targeting nicotine replacement therapy (NRT) are cost-effective strategies for reducing adverse health consequences for smokers. Treatment studies document the efficacy of pre-cessation NRT and support important roles for level of nicotine dependence and pre-cessation smoking reduction in successful quitting. However, prior work has not identified the optimal pre-cessation dose or means for personalizing NRT. Genome wide association has identified groups of genomic markers that are associated with successful quitting, allowing us to develop a v1.0 "quit success" genotype score. We now report influences of v1.0 quit success genotype score, level of dependence and pre-cessation smoking reduction in a smoking cessation trial that examined effects of 21 vs 42 mg/24 h pre-cessation NRT. 479 smokers were randomized to 21 or 42 mg NRT, initiated 2 weeks prior to target quit dates.We monitored self-reported abstinence and end-expired air carbon monoxide (CO). Genotyping used Affymetrix arrays. The primary outcome was 10-week continuous smoking abstinence. NRT dose, level of nicotine dependence and genotype scores displayed significant interactive effects on successful quitting. Successful abstinence was also predicted by CO reductions during pre-cessation NRT. These results document ways in which smoking cessation strategies can be personalized based on levels of nicotine dependence, genotype scores and CO monitoring. These assessments, taken together, can help to match most smokers with optimal NRT doses and to rapidly identify some who may be better treated using other methods. Molecular Medicine www.molmed.org UNCORRECTED PROOFCigarette smoking is a significant cause of premature death and disease 1 . Successfully quitting and maintaining abstinence reduce risks to smokers [2][3][4] . However, success rates following attempts to quit smoking remain modest. One year after unaided attempts to quit smoking, abstinence rates are less than 5% 5,6 . Even with pharmacologic aids that include nicotine replacement therapy (NRT), bupropion and varenicline, long-term abstinence rates are less than 25% 7, 8 .Pre-cessation NRT initiates nicotine patch treatment two weeks prior to a target quit date 9, 10 . The 21 mg/24 hour dose pre-cessation dose used to date is well tolerated by most smokers 9, 10 and consistently enhances quit rates: recent meta-analyses show a 1.8-2.2 fold greater likelihood of success than conventional NRT 11,12 . However, neither dose/response data nor clear-cut recommendations for personalizing pre-cessation NRT have been reported.More effective smoking cessation might result from personalizing existing treatments based on characteristics of individual smokers. Previous research has identified phenotypic and genotypic variables that might aid in predicting likelihood of success in smoking cessation and/or differential responses to different treatment regimens. In smoking cessation trials, smokers who score higher on the Fagerström Test for Nicotine Dependence (FTND), and thus display ...

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Section: Discussionmentioning

confidence: 99%

Personalized Smoking Cessation: Interactions between Nicotine Dose, Dependence and Quit-Success Genotype Score

Rose

Behm

Drgon

et al. 2010

Mol Med

131

104

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“…[29] In a Japanese study using an alternative Markov model and conducted from a healthcare payer perspective, 12 weeks' therapy with varenicline dominated counselling alone, with regard to the incremental cost per QALY gained. [37] Additional BENESCO analyses (conducted in Sweden, [35] the US [36] and Scotland [24] ) estimated that when only direct costs were considered, an additional 12 weeks of varenicline therapy was associated with acceptable incremental costs per QALY gained versus varenicline for 12 weeks alone, [24,35,36] and dominated bupropion SR, [36] nicotine replacement therapy [36] or unaided cessation, [36] with regard to the cost per QALY gained. The cost effectiveness of an additional 12 weeks of varenicline therapy, versus 12 weeks alone, was maintained when indirect costs were also considered.…”

Section: Pharmacoeconomic Analyses Of Vareniclinementioning

confidence: 99%

Pharmacoeconomic Spotlight on Varenicline as an Aid to Smoking Cessation†

Keating

Lyseng‐Williamson

2010

CNS Drugs

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Varenicline (Chantix, Champix) is an orally administered alpha4beta2 nicotinic acetylcholine receptor partial agonist that is indicated as an aid to smoking cessation. Varenicline was an effective aid to smoking cessation and was generally well tolerated in clinical trials, although more data are needed regarding the potential for neuropsychiatric events. The costs associated with varenicline are offset by direct savings associated with the reduction in smoking-related diseases. Indeed, despite their limitations, available pharmacoeconomic analyses from numerous countries support the use of varenicline for 12 or 24 weeks as a cost-effective treatment relative to other smoking cessation therapies in smokers who wish to quit smoking. For example, in modelled cost-effectiveness analyses conducted from a healthcare payer perspective, 12 weeks' treatment with varenicline consistently dominated bupropion sustained release and nicotine replacement therapy, and was dominant over, or considered cost effective relative to, unaided cessation, brief counselling or nortriptyline, with regard to the incremental costs per quality-adjusted life-year or life-year gained.

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“…A significant part of the intervention was smoking cessation programmes, either pharmacotherapy 4, 5, 36, 37, 38, 40, 41, 48, 50, 51, 53, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, behavioural therapy 6, 42, 47, 66, 67, 68, 69 or a combination of these 33, 34, 35, 43, 45, 46, 49, 52, 54, 70, 71, 72, 73, 74, 75. Several studies evaluated wider tobacco control interventions 39, 44, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, whereas five studies included both smoking cessation programmes and tobacco control interventions 89, 90, 91, 92, 93.…”

Section: Resultsmentioning

confidence: 99%

“…In total, 23 of 64 studies reported QALY as their main outcome 5, 35, 38, 40, 41, 47, 48, 49, 56, 58, 59, 61, 62, 63, 65, 69, 70, 76, 78, 81, 86, 88, 94, followed by life years (LY) gained ( n = nine of 64) 33, 43, 46, 66, 67, 68, 73, 74, 89 or a combination of these ( n = 12 of 64) 4, 6, 35, 36, 37, 39, 42, 44, 57, 77, 80, 83. Five of 64 studies reported disability adjusted life years (DALY) as their main outcome 60, 82, 90, 91, 92, and only four of 64 (incremental) net benefit 52, 53, 55, 71.…”

Section: Resultsmentioning

confidence: 99%

Model‐based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review

et al. 2017

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AimsTo identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context.MethodsA systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, National Health Service (NHS) Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA). The checklist‐based quality of the included studies and transferability scores was based on the European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not original research, not a model‐based economic evaluation, that did not consider adult population and not from a high‐income country were excluded.FindingsAmong the 64 economic evaluations included in the review, the state‐transition Markov model was the most frequently used method (n = 30/64), with quality adjusted life years (QALY) being the most frequently used outcome measure in a life‐time horizon. A small number of the included studies (13 of 64) were eligible for EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97, with an average score of 0.75. The average score per section was 0.69 (range = 0.35–0.92). The relative transferability of the studies could not be established due to a limitation present in the EURONHEED method.ConclusionAll existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context.

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Cost-Utility Analysis of Varenicline, an Oral Smoking-Cessation Drug, in Japan

Cited by 35 publications

References 25 publications

Personalized Smoking Cessation: Interactions between Nicotine Dose, Dependence and Quit-Success Genotype Score

Personalized Smoking Cessation: Interactions between Nicotine Dose, Dependence and Quit-Success Genotype Score

Pharmacoeconomic Spotlight on Varenicline as an Aid to Smoking Cessation†

Model‐based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review

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