title: An economic evaluation based on a randomized placebo-controlled trial of varenicline in smokers with cardiovascular disease: results for Belgium, Spain, Portugal, and Italy.
abstract: BACKGROUND
  An estimated 17.2% of patients continue to smoke following diagnosis of cardiovascular disease (CVD). To reduce the risk of further morbidity or mortality in cardiovascular patients, smoking cessation has been shown to reduce the risk of mortality by 36% and myocardial infarction by 32%. The objective of this study was to evaluate the long-term health and economic consequences of smoking cessation in patients with CVD.
  
  
  METHODS
  Results of a randomized clinical trial comparing varenicline plus counselling vs. placebo plus counselling were extrapolated using a Markov model to simulate the lifetime costs and health consequences of smoking cessation in patients with stable CVD. For the base case, we considered a payer's perspective including direct costs attributed to the healthcare provider, measuring cumulative life years (LY) and quality adjusted life (QALY) years as outcome measures. Secondary analyses were conducted from a societal perspective, evaluating lost productivity due to premature mortality. Sensitivity and subgroup analyses were also undertaken. Results were analysed for Belgium, Spain, Portugal, and Italy.
  
  
  RESULTS
  Varenicline plus counselling was associated with a gain in LY and QALY across all countries; relative to placebo plus counselling. From a payer's perspective, incremental cost effectiveness ratios were € 6120 (Belgium), € 5151 (Spain), € 5357 (Portugal), and € 5433 (Italy) per QALY gained. From a societal perspective, varenicline in addition to counselling was less costly than placebo and counselling in all cases. Sensitivity analyses showed little sensitivity in outcomes to model assumptions or uncertainty in model parameters.
  
  
  CONCLUSIONS
  Varenicline in addition to counselling is cost-effective compared to placebo and counselling in smokers with CVD.
authors.affiliation: Pfizer Ltd, Surrey, UK. koo.wilson@pfizer.com
authors.forename: Koo
authors.initials: K
authors.lastname: Wilson
authors.forename: Robert
authors.initials: R
authors.lastname: Hettle
authors.forename: Sophie
authors.initials: S
authors.lastname: Marbaix
authors.forename: Silvia
authors.initials: S
authors.lastname: Diaz Cerezo
authors.forename: Monica
authors.initials: M
authors.lastname: Ines
authors.forename: Laura
authors.initials: L
authors.lastname: Santoni
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.forename: Jacques
authors.initials: J
authors.lastname: Prignot
authors.forename: Esteban
authors.initials: E
authors.lastname: Lopez de Sa
mesh_terms: D001530:Belgium / Q000453:epidemiology; D001552:Benzazepines / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000191:economics / Q000627:therapeutic use; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D011810:Quinoxalines / Q000191:economics / Q000627:therapeutic use*; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D011810:Quinoxalines; D000068580:Varenicline