Cost-Effectiveness of Varenicline Compared to Placebo as an Aid to Smoking Cessation in Patients with Cardiovascular Disease
Robert Hettle*, 1, Koo Wilson2, Tunde Peter3, Juris Ezernieks4, Dieter Hackl5, Christopher Wolf6
Identifiers and Pagination:Year: 2012
First Page: 8
Last Page: 17
Publisher Id: TOPHARMEJ-4-8
Article History:Received Date: 22/11/2011
Revision Received Date: 17/1/2012
Acceptance Date: 23/01/2012
Electronic publication date: 22/3/2012
Collection year: 2012
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Varenicline has been shown to be an effective and well-tolerated intervention for smoking cessation in smokers with stable cardiovascular disease (CVD). The objective of this study was to evaluate the costeffectiveness of varenicline and counselling compared to placebo and counselling based on extrapolating the results of a 52-week randomised controlled trial.
A Markov model was developed to simulate the outcomes of smokers with CVD. Outcomes included major forms of CVD (e.g. Coronary Heart Disease [CHD]) and other key chronic conditions attributable to smoking (e.g. Lung Cancer). The lifetime costs, Life-Years gained (LY) and Quality-Adjusted Life Years (QALY) were evaluated from a payer's perspective in Austria, Hungary and Germany. Additional analyses included a societal perspective, disease subgroup, and both one-way and probabilistic sensitivity analyses (PSA). Costs and outcomes were discounted at 3% per year.
From a payer's perspective, the incremental cost-effectiveness ratio per LY (or QALY) gained was €4 112 (€5 278), €2 507 (€3 183), and €4 567 (€5 867) for Austria, Hungary and Germany, respectively. Sub-group analyses demonstrated that smoking cessation in patients with CHD was more cost-effective than in patients with baseline stroke or peripheral vascular disease. Sensitivity analysis demonstrated that outcomes were not sensitive to modelling assumptions. Varenicline was less costly and more effective than placebo from a societal perspective, and more costly and more effective than placebo in all iterations of the payer PSA.
Varenicline is a cost-effective adjunct to counselling compared to counselling alone in patients with stable CVD.