The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles.
OBJECTIVE
To examine the incremental cost effectiveness of the five first line pharmacological smoking cessation therapies in the Seychelles and other developing countries.


METHODS
A Markov chain cohort simulation.


METHODS
Two simulated cohorts of smokers: (1) a reference cohort given physician counselling only; (2) a treatment cohort given counselling plus cessation therapy.


METHODS
Addition of each of the five pharmacological cessation therapies to physician provided smoking cessation counselling.


METHODS
Cost per life-year saved (LYS) associated with the five pharmacotherapies. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications.


RESULTS
Based on prices for currently available generic medications on the global market, the incremental cost per LYS for a 45 year old in the Seychelles was 599 US dollars for gum and 227 dollars for bupropion. Assuming US treatment prices as a conservative estimate, the incremental cost per LYS was significantly higher, though still favourable in comparison to other common medical interventions: 3712 dollars for nicotine gum, 1982 dollars for nicotine patch, 4597 dollars for nicotine spray, 4291 dollars for nicotine inhaler, and 1324 dollars for bupropion. Cost per LYS increased significantly upon application of higher discount rates, which may be used to reflect relatively high opportunity costs for health expenditures in developing countries with highly constrained resources and high overall mortality.


CONCLUSIONS
Pharmacological cessation therapy can be highly cost effective as compared to other common medical interventions in low mortality, middle income countries, particularly if medications can be procured at low prices.
Gilbert
A R
AR
Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland. ag@email.unc.edu <ag@email.unc.edu>
Pinget
C
C
Bovet
P
P
Cornuz
J
J
Shamlaye
C
C
Paccaud
F
F
D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003376:Counseling; D003906:Developing Countries; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D055502:Secondary Prevention; D012750:Seychelles / Q000453:epidemiology; D012907:Smoking / Q000188:drug therapy* / Q000401:mortality; D016540:Smoking Cessation / Q000191:economics*