Systematic review of the cost-effectiveness of varenicline vs. bupropion for smoking cessation

Mahmoudi, Mandana; Coleman, Craig I.; Sobieraj, Diana M

doi:10.1111/j.1742-1241.2011.02877.x

Cited by 24 publications

(28 citation statements)

References 32 publications

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“…Several systematic reviews are available on the cost‐effectiveness of smoking cessation 22, 23, 24, but only one systematic review looking at model‐based economic evaluations 20. Most of the studies included in their review used the Markov model with long‐term time horizons, included comparable health states and reported the similar measures of effectiveness and outcomes as ours, and common weaknesses included poor reporting of the modelling details.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, limiting the search to English language only might have excluded some studies. However, we identified more model‐based economic evaluations than a previous similar review 22. The use of three quality criteria 31 for inclusion of studies in the transferability assessment could potentially have introduced some bias, as it was based on the overall assessment, as opposed to some standard checklists such as those by Drummond 103 or Philips 104.…”

Section: Discussionmentioning

confidence: 99%

“…They were searched for publications in English language between 1996 and April 2015. The search strategy was based on related published systematic reviews 20, 22, 23, 24, leading to the final search terms ‘smoking’, ‘nicotine’ and ‘tobacco’ in NHS EED and HTA. Medline and EMBASE required additional terms related to model‐based economic evaluation, which were based on Wilczynski et al .…”

Section: Methodsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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“…Pharmacotherapy for smoking cessation in Germany includes medications such as bupropion, an antidepressant, and varenicline, a partial nicotine receptor agonist. Varenicline has been shown to be more cost‐effective than bupropion 22 for smoking cessation. However, in Germany, over‐the‐counter nicotine replacement therapies (NRT) such as nicotine patches and gums are used significantly more frequently for smoking cessation than prescription drugs (approximately 20 versus 1%) 15, although they are less effective 23, 24.…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

Huber¹,

Präger²,

Coyle

et al. 2017

Addiction

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AimsTo evaluate costs, effects and cost‐effectiveness of increased reach of specific smoking cessation interventions in Germany.DesignA Markov‐based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health‐care perspective (extended to include out‐of‐pocket payments) with life‐time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates.SettingGermany.ParticipantsCohort of current smoking population (18+ years) in Germany.InterventionsInterventions included group‐based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group‐based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England.MeasurementsEQUIPTMOD considered reach, intervention cost, number of quitters, quality‐of‐life years (QALYs) gained, cost‐effectiveness and return on investment.FindingsThe highest returns through reduction in smoking‐related health‐care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group‐based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost‐savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return‐on‐investment estimates. At a hypothetical willingness‐to‐pay threshold of only €5000, the probability of being cost‐effective is approximately 75% for prospective scenario 1.ConclusionsIncreasing the reach of group‐based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost‐effective.

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“…Varenicline has been shown to be more cost-effective than either NRT or bupropion, though estimates vary greatly due to different methodologies [409][410][411]. The cost per additional quitter for varenicline is approximately £2,170 (US$ 3139) [412].…”

Section: Vareniclinementioning

confidence: 99%

New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?

et al. 2016

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A wide range of support is available to help smokers to quit and aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that the needs of tobacco users are met. This paper compares the first-line smoking cessation medications to: 1) two variants of these existing products: new galenic formulations of varenicline and novel nicotine delivery devices; and 2) twenty-four alternative products: cytisine (novel outside of central and eastern Europe), nortriptyline, other tricyclic antidepressants, electronic cigarettes, clonidine (an anxiolytic), other anxiolytics (e.g. buspirone), selective 5-hydroxytryptamine Key points: This paper reviews 26 pharmacotherapies that have been investigated for tobacco harm reduction and smoking cessation alongside three first-line treatments (nicotine replacement therapy, varenicline and bupropion) on six criteria: relative efficacy, relative safety, relative cost, relative use, relative scope, and relative ease of use. Although many of these products are in the early stages of clinical trials, of all the medications considered, cytisine appears to offers the best prospect for the future, having established safety and efficacy and being very inexpensive. Electronic cigarettes have become very popular in some countries but efficacy and long-term safety compared with other treatment profiles require further consideration.

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Systematic review of the cost-effectiveness of varenicline vs. bupropion for smoking cessation

Cited by 24 publications

References 32 publications

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

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

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?

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