Cost-effectiveness of pharmacotherapies for nicotine dependence in primary care settings: a multinational comparison.
OBJECTIVE
To estimate the incremental cost-effectiveness of the first-line pharmacotherapies (nicotine gum, patch, spray, inhaler, and bupropion) for smoking cessation across six Western countries-Canada, France, Spain, Switzerland, the United States, and the United Kingdom.


METHODS
A Markov-chain cohort model to simulate two cohorts of smokers: (1) a reference cohort given brief cessation counselling by a general practitioner (GP); (2) a treatment cohort given counselling plus pharmacotherapy. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications.


METHODS
Addition of each first-line pharmacotherapy to GP cessation counselling.


METHODS
Cost per life-year saved associated with pharmacotherapies.


RESULTS
The cost per life-year saved for counselling only ranged from US190 dollars in Spain to 773 dollars in the UK for men, and from 288 dollars in Spain to 1168 dollars in the UK for women. The incremental cost per life-year saved for gum ranged from 2230 dollars for men in Spain to 7643 dollars for women in the US; for patch from 1758 dollars for men in Spain to 5131 dollars for women in the UK; for spray from 1935 dollars for men in Spain to 7969 dollars for women in the US; for inhaler from 3480 dollars for men in Switzerland to 8700 dollars for women in France; and for bupropion from 792 dollars for men in Canada to 2922 dollars for women in the US. In sensitivity analysis, changes in discount rate, treatment effectiveness, and natural quit rate had the strongest influences on cost-effectiveness.


CONCLUSIONS
The cost-effectiveness of the pharmacotherapies varied significantly across the six study countries, however, in each case, the results would be considered favourable as compared to other common preventive pharmacotherapies.
Cornuz
J
J
Department of Ambulatory and Community Medicine, University Hospital, CH-1011 Lausanne, Switzerland. jacques.cornuz@chuv.hospvd.ch
Gilbert
A
A
Pinget
C
C
McDonald
P
P
Slama
K
K
Salto
E
E
Paccaud
F
F
D000328:Adult; D000367:Age Factors; D000569:Americas; D016642:Bupropion / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D012008:Recurrence; D012737:Sex Factors; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D014029:Tobacco Use Disorder / Q000188:drug therapy* / Q000191:economics; D016896:Treatment Outcome
D016642:Bupropion; D009538:Nicotine