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
1 Health Economic Modelling Unit, HERON Evidence Development Ltd., Building 210a, Butterfield Technology and Business Park, Stopsley, Luton LU2 8DL, UK
2 Pfizer Limited, IPC 5-G-27, Walton Oaks, Dorking Road, Walton-on-the-Hill, Surrey, KT20 7NS, UK
3 Pfizer Hungary, Budapest, Alkotás street 53., 1123, Hungary
4 Pfizer Deutschland GmbH, Linkstr. 10. Postfach 61 01 94, D-1078, 5 Berlin. 10922 Berlin, Germany
5 Pfizer Corporation Austria Gesellschaft m.b.H., FN 126844k HG Wien, Floridsdorfer Hauptstrasse 1, A - 1210 Wien, Austria
6 Medizinische Abteilung, Sozialmedizinisches Zentrum Ost – Donauspital, Langobardenstraße 122, 1220 Wien, Austria


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© Hettle et al.;

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.

* Address correspondence to this author at the Health Economic Modelling Unit, HERON Evidence Development Ltd., Building 210a, Butterfield Technology and Business Park, Stopsley, Luton LU2 8DL, UK. Tel: +44 (0)1582 433650; Fax: +44 (0)1582 433651; E-mail: Robert.Hettle@heronhealth.com


Abstract

Background:

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.

Method:

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.

Results:

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.

Conclusions:

Varenicline is a cost-effective adjunct to counselling compared to counselling alone in patients with stable CVD.

Keywords: Smoking cessation, varencline, cardiovascular disease, cost-effectiveness.