Healthcare Costs of Smokers Using Varenicline Versus Nicotine-Replacement Therapy Patch in the United States: Evidence from Real-World Practice

Lee, Lauren J.; Li, Qian; Bruno, Marianna; Emir, Birol; Murphy, Brian R.; Shah, Surbhi; Reynolds, Matthew W.; Marchant, Nick; Park, Peter W.

doi:10.1007/s12325-018-0858-y

Cited by 7 publications

(12 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13 Conversely, another study using national claims databases in the US reported fewer smoking attributable outcomes (and lower healthcare costs) in patients receiving varenicline compared to NRT, although mortality was not reported. 14 We believe that while the magnitude of mortality estimates are uncertain, the overall public health impact is almost certainly conservative, as we did not assume an increase in utilization of varenicline (as would be suggested by the rapid uptake of the medication from 2006–2008). Moreover, we only estimated its effects on mortality, and only during the limited time period of observation.…”

Section: Discussionmentioning

confidence: 95%

Varenicline and Nicotine Replacement Use Associated With US Food and Drug Administration Drug Safety Communications

et al. 2019

View full text Add to dashboard Cite

Importance Drug safety communications released by the Food and Drug Administration (FDA) are often based on limited evidence on safety signals post-approval. Varenicline constitutes an interesting case study, because it was the target of several FDA communications in 2008 and 2009; ultimately the EAGLES trial dismissed safety concerns on increased suicidal thoughts and aggressive and erratic behavior in 2016. Objective To examine the association between FDA drug safety communications and the utilization of varenicline. Design/ Setting/ Participants/ Exposures Retrospective longitudinal study of 2002–2018 VHA outpatient data and 2006–2018 Medicaid drug state utilization data. Main Outcomes/Measures We extracted prescribing records for varenicline and nicotine replacement therapy (NRT) in VHA and measured the number of unique varenicline and NRT users in VHA per quarter. We implemented an interrupted time-series analysis to describe the association between FDA safety warnings and the utilization of varenicline and of NRT. To test the generalizability of our findings, we duplicated similar analyses using the number of prescriptions reimbursed for varenicline by Medicaid every quarter in 2006–2018. Results After its addition to VHA national drug formulary in January 2007, varenicline presented a rapid uptake growing from 70 to over 50,000 prescriptions by the end of the year. Within 12 months of the 2008 public health advisory, quarterly varenicline utilization decreased by 68.7% from 32,581 to 10,182 patients (p-value for trend change<0.001), while NRT utilization increased by 32.1%, from 55,728 to 73,629 patients (p-value for trend change<0.001). In Medicaid, varenicline utilization decreased by 38.0% from 109,308 to 67,761 prescriptions within 12 months of the 2008 public health advisory (p-value for trend change<0.001). Twelve months after the publication of the EAGLES trial, which showed no significant increase in psychiatric/behavioral effects with varenicline relative to nicotine replacement therapy (NRT), utilization increased by 42.7% in VHA patients (p-value for trend change=0.01), and by 26.0% in Medicaid (p-value for trend change=0.26). Conclusions and Relevance Using varenicline as a case study, we found that early communications from the FDA and VHA followed by a labelling change was associated with a considerable decrease in drug utilization, which may have been associated with negative public health consequences.

show abstract

Section: Discussionmentioning

confidence: 95%

Varenicline and Nicotine Replacement Use Associated With US Food and Drug Administration Drug Safety Communications

et al. 2019

View full text Add to dashboard Cite

show abstract

“…[4][5][6] Yet, the translation of clinical effectiveness of smoking cessation treatment on healthcare service use using real-world evidence has received limited attention in the literature. 7 Prior research has largely focused on the effect of smoking cessation treatment provided to hospitalised patients on subsequent re-hospitalisation. [8][9][10][11][12] Overall, the evidence suggests that hospital-based cessation programmes can lower re-admission rates.…”

Section: Introductionmentioning

confidence: 99%

Primary care-based smoking cessation treatment and subsequent healthcare service utilisation: a matched cohort study of smokers using linked administrative healthcare data

et al. 2021

View full text Add to dashboard Cite

BackgroundNo research has assessed the individual-level impact of smoking cessation treatment delivered within a general primary care patient population on multiple forms of subsequent healthcare service use.ObjectiveWe aimed to compare the rate of outpatient visits, emergency department (ED) visits and hospitalisations during a 5-year follow-up period among smokers who had and had not accessed a smoking cessation treatment programme.MethodsThe study was a retrospective matched cohort study using linked demographic and administrative healthcare databases in Ontario, Canada. 9951 patients who accessed smoking cessation services between July 2011 and December 2012 were matched to a smoker who did not access services, obtained from the Canadian Community Health Survey, using a combination of hard matching and propensity score matching. Outcomes were rates of healthcare service use from index date (programme enrolment or survey response) to March 2017.ResultsAfter controlling for potential confounders, patients in the overall treatment cohort had modestly greater rates of the outcomes: outpatient visits (rate ratio (RR) 1.10, 95% CI: 1.06 to 1.14), ED visits (RR 1.08, 95% CI: 1.03 to 1.13) and hospitalisations (RR 1.09, 95% CI: 1.02 to 1.18). Effect modification of the association between smoking cessation treatment and healthcare service use by prevalent comorbidity was found for outpatient visits (p=0.006), and hospitalisations (p=0.050), but not ED visits.ConclusionsPatients who enrolled in smoking cessation treatment offered through primary care clinics in Ontario displayed a modest but significantly greater rate of outpatient visits, ED visits and hospitalisations over a 5-year follow-up period.

show abstract

“…Based on the authors' experience, Varenicline is even less available and accessible given its higher price and single global patent holder (Lee et al, 2019). It is also noteworthy that just over 25% of countries partially or wholly cover costs of cessation treatments and services.…”

Section: Market Access and Affordability Gapmentioning

confidence: 99%

Overcoming barriers to disseminate effective smoking cessation treatments globally

Patwardhan¹,

Rose

2020

DAT

View full text Add to dashboard Cite

Purpose The purpose of this paper is to review the barriers in the dissemination of effective smoking cessation treatments and services globally. Offering tobacco users help to stop using tobacco is a key demand reduction measure outlined under Article 14 of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC). Implementing Article 14 can reap great dividends for the billion plus tobacco users around the world and their families, friends and societies. Design/methodology/approach A review of the status of the global implementation of Article 14 using available literature on smoking cessation products, services and national guidelines. Discussing innovative approaches being currently explored in South Asia that can lead to faster adoption and implementation of Article 14 globally. Findings Major gaps remain in cessation products’ availability and resource allocation for cessation services globally. Current licensed products are falling short on delivering and sustaining smoking cessation. Innovation in cessation products and services needs to build on learnings in nicotine pharmacokinetics, behavioural insights from consumer research and tap into 21st century tools such as mobile based apps. National implementation of FCTC’s Article 14 needs to follow guidelines that encourage integration into existing health programmes and health-care practitioners’ (HCPs) upskilling. Originality/value Smoking cessation is a desirable health outcome and nicotine replacement products are a means of achieving cessation through tobacco harm reduction. E-cigarettes are sophisticated nicotine replacement products. Innovation is urgently needed to fill the gaps in smoking cessation products and services, and for converting global policy into local practice. In low- and middle-income countries (LMICs), HCPs’ knowledge, attitudes and practice regarding tobacco use and cessation may hold the key to rapidly scaling up cessation support and delivery to achieve FCTC objectives sooner. Additionally, HCPs can play an important role in offering smoking cessation support in existing national health programmes for TB, cancer screening and maternal and child health. Also, widely prevalent smartphone devices may deliver smoking cessation through telemedicine in LMICs sooner, leapfrogging the hurdles of the existing health-care infrastructure.

show abstract

Healthcare Costs of Smokers Using Varenicline Versus Nicotine-Replacement Therapy Patch in the United States: Evidence from Real-World Practice

Cited by 7 publications

References 37 publications

Varenicline and Nicotine Replacement Use Associated With US Food and Drug Administration Drug Safety Communications

Varenicline and Nicotine Replacement Use Associated With US Food and Drug Administration Drug Safety Communications

Primary care-based smoking cessation treatment and subsequent healthcare service utilisation: a matched cohort study of smokers using linked administrative healthcare data

Overcoming barriers to disseminate effective smoking cessation treatments globally

Contact Info

Product

Resources

About