Citation

Keeney E, Welton NJ, Stevenson M, Dalili MN, López-López JA, Caldwell DM, Phillippo DM, Munafò MR, Thomas KH. Value Health 2021; 24(6): 780-788.

Copyright

(Copyright © 2021, International Society for Pharmacoeconomics and Outcomes Research, Publisher John Wiley and Sons)

DOI

10.1016/j.jval.2020.12.012

PMID

34119075

PMCID

PMC8177405

Abstract

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.

Language: en

Keywords

Humans; Risk Factors; Depression; Risk Assessment; Time Factors; Self-Injurious Behavior; Treatment Outcome; Cost-Benefit Analysis; United Kingdom; Markov Chains; Smoking; Recurrence; Quality-Adjusted Life Years; smoking cessation; Drug Costs; Models, Economic; Nicotinic Agonists; Varenicline; cost-effectiveness; Bupropion; Electronic Nicotine Delivery Systems; Network Meta-Analysis; economic model; Monte Carlo Method; Smoking Cessation; Smoking Cessation Agents; Tobacco Use Cessation Devices; value of information