Cost-Effectiveness Analysis of Smoking Cessation Interventions in the United Kingdom Accounting for Major Neuropsychiatric Adverse Events

Jun 1, 2021, 00:00 AM
10.1016/j.jval.2020.12.012
https://www.valueinhealthjournal.com/article/S1098-3015(21)00054-1/fulltext
Section Title : ECONOMIC EVALUATION
Section Order : 780
First Page : 780

Objectives

Smoking is a leading cause of death worldwide. Cessation aids include varenicline, bupropion, nicotine replacement therapy (NRT), and e-cigarettes at various doses (low, standard and high) and used alone or in combination with each other. Previous cost-effectiveness analyses have not fully accounted for adverse effects nor compared all cessation aids. The objective was to determine the relative cost-effectiveness of cessation aids in the United Kingdom.

Methods

An established Markov cohort model was adapted to incorporate health outcomes and costs due to depression and self-harm associated with cessation aids, alongside other health events. Relative efficacy in terms of abstinence and major adverse neuropsychiatric events was informed by a systematic review and network meta-analysis. Base case results are reported for UK-licensed interventions only. Two sensitivity analyses are reported, one including unlicensed interventions and another comparing all cessation aids but removing the impact of depression and self-harm. The sensitivity of conclusions to model inputs was assessed by calculating the expected value of partial perfect information.

Results

When limited to UK-licensed interventions, varenicline standard-dose and NRT standard-dose were most cost-effective. Including unlicensed interventions, e-cigarette low-dose appeared most cost-effective followed by varenicline standard-dose + bupropion standard-dose combined. When the impact of depression and self-harm was excluded, varenicline standard-dose + NRT standard-dose was most cost-effective, followed by varenicline low-dose + NRT standard-dose.

Conclusion

Although found to be most cost-effective, combined therapy is currently unlicensed in the United Kingdom and the safety of e-cigarettes remains uncertain. The value-of-information analysis suggested researchers should continue to investigate the long-term effectiveness and safety outcomes of e-cigarettes in studies with active comparators.

https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(21)00054-1&doi=10.1016/j.jval.2020.12.012
HEOR Topics :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Economic Evaluation
  • Methodological & Statistical Research
  • Modeling and simulation
  • Respiratory-Related Disorders
  • Specific Diseases & Conditions
  • Value of Information
Tags :
  • cost-effectiveness
  • economic model
  • smoking cessation
  • value of information
Regions :
  • Eastern and Central Europe