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- Title
Economic Evaluation of Enhanced vs Standard Varenicline Treatment for Tobacco Cessation.
- Authors
Mundt, Marlon P.; Stein, James H.; Fiore, Michael C.; Baker, Timothy B.
- Abstract
Key Points: Question: What is the cost-effectiveness of enhanced varenicline treatment (extended varenicline use or varenicline in combination with nicotine replacement therapy) among individuals trying to quit smoking? Findings: In this economic evaluation of enhanced varenicline treatment for smoking cessation that included 1251 participants, the incremental cost-effectiveness ratio was $4579 per quality-adjusted life-year (QALY) for 12-week varenicline monotherapy. In contrast, 24-week varenicline combination therapy cost $90 000 000 per additional QALY relative to 12-week varenicline monotherapy. Meaning: This study suggests that standard 12-week varenicline monotherapy is the most cost-effective treatment option for smoking cessation at the commonly cited threshold of $100 000/QALY. Importance: Smoking is the leading preventable cause of death and illness in the US. Identifying cost-effective smoking cessation treatment may increase the likelihood that health systems deliver such treatment to their patients who smoke. Objective: To evaluate the cost-effectiveness of standard vs enhanced varenicline use (extended varenicline treatment or varenicline in combination with nicotine replacement therapy) among individuals trying to quit smoking. Design, Setting, and Participants: This economic evaluation assesses the Quitting Using Intensive Treatments Study (QUITS), which randomized 1251 study participants who smoked into 4 conditions: (1) 12-week varenicline monotherapy (n = 315); (2) 24-week varenicline monotherapy (n = 311); (3) 12-week varenicline combination treatment with nicotine replacement therapy patch (n = 314); or (4) 24-week varenicline combination treatment with nicotine replacement therapy patch (n = 311). Study enrollment occurred in Madison and Milwaukee, Wisconsin, between November 11, 2017, and July 2, 2020. Statistical analysis took place from May to October 2023. Main Outcomes and Measures: The primary outcome was 7-day point prevalence abstinence (biochemically confirmed with exhaled carbon monoxide level ≤5 ppm) at 52 weeks. The incremental cost-effectiveness ratio (ICER), or cost per additional person who quit smoking, was calculated using decision tree analysis based on abstinence and cost for each arm of the trial. Results: Of the 1251 participants, mean (SD) age was 49.1 (11.9) years, 675 (54.0%) were women, and 881 (70.4%) completed the 52-week follow-up. Tobacco cessation at 52 weeks was 25.1% (79 of 315) for 12-week monotherapy, 24.4% (76 of 311) for 24-week monotherapy, 23.6% (74 of 314) for 12-week combination therapy, and 25.1% (78 of 311) for 24-week combination therapy, respectively. The total mean (SD) cost was $1175 ($365) for 12-week monotherapy, $1374 ($412) for 12-week combination therapy, $2022 ($813) for 24-week monotherapy, and $2118 ($1058) for 24-week combination therapy. The ICER for 12-week varenicline monotherapy was $4681 per individual who quit smoking and $4579 per quality-adjusted life-year (QALY) added. The ICER for 24-week varenicline combination therapy relative to 12-week monotherapy was $92 000 000 per additional individual who quit smoking and $90 000 000 (95% CI, $15 703 to dominated or more costly and less efficacious) per additional QALY. Conclusions and Relevance: This economic evaluation of standard vs enhanced varenicline treatment for smoking cessation suggests that 12-week varenicline monotherapy was the most cost-effective treatment option at the commonly cited threshold of $100 000/QALY. This study provides patients, health care professionals, and other stakeholders with increased understanding of the health and economic impact of more intensive varenicline treatment options. This economic evaluation examines the cost-effectiveness of varenicline monotherapy vs varenicline treatment in combination with patch nicotine replacement therapy for smoking cessation when both types of treatment are offered at standard of care and extended durations.
- Subjects
SMOKING cessation; COMBINATION drug therapy; PATIENT compliance; NICOTINE replacement therapy; COST effectiveness; RESEARCH funding; STATISTICAL sampling; BLIND experiment; QUESTIONNAIRES; HUMAN research subjects; RANDOMIZED controlled trials; TREATMENT duration; DESCRIPTIVE statistics; RACE; INFORMED consent (Medical law); DRUGS; COUNSELING; HEALTH outcome assessment; CONFIDENCE intervals; VARENICLINE; MEDICAL care costs; PHARMACODYNAMICS
- Publication
JAMA Network Open, 2024, Vol 7, Issue 4, pe248727
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.8727