title: Cost-effectiveness of bupropion, nortriptyline, and psychological intervention in smoking cessation.
abstract: Sustained-release bupropion and nortriptyline have been shown to be efficacious in treating cigarette smoking. Psychological intervention is also recognized as efficacious. The cost and cost-effectiveness of the 2 drug therapies have not been estimated. It was hypothesized that nortriptyline would be more cost-effective than bupropion. Hypotheses were not originally proposed concerning the cost-effectiveness of psychological versus drug treatment, but the 2 were compared using exploratory analyses. This was a 3 (bupropion versus nortriptyline versus placebo) by 2 (medical management alone versus medical management plus psychological intervention) randomized trial. Participants were 220 cigarette smokers. Outcome measures were cost and cost-effectiveness computed at week 52. Nortriptyline cost less than bupropion. Nortriptyline was more cost-effective than bupropion; the difference was not statistically significant. Psychological intervention cost less than the 2 drug treatments, and was more cost-effective, but not significantly so. Prospective investigations of the cost and cost-effectiveness of psychological and pharmacological intervention, using adequate sample sizes, are warranted.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, 94143, USA. smh@itsa.ucsf.edu
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Hall
authors.forename: James M
authors.initials: JM
authors.lastname: Lightwood
authors.forename: Gary L
authors.initials: GL
authors.lastname: Humfleet
authors.forename: Alan
authors.initials: A
authors.lastname: Bostrom
authors.forename: Victor I
authors.initials: VI
authors.lastname: Reus
authors.forename: Ricardo
authors.initials: R
authors.lastname: Muñoz
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion / Q000191:economics* / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000191:economics* / Q000627:therapeutic use; D010348:Patient Care Team / Q000191:economics; D011615:Psychotherapy, Group / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics; D016540:Smoking Cessation / Q000191:economics* / Q000523:psychology
chemical_list: D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D003692:Delayed-Action Preparations; D016642:Bupropion; D009661:Nortriptyline