title: Cost analysis of varenicline versus bupropion, nicotine replacement therapy, and unaided cessation in Nicaragua.
abstract: OBJECTIVE
  In Nicaragua, 30% of current morbidities are associated with tobacco smoking. Tobacco control policy measures have been initiated in this Central American country; however, the population does not have a complete understanding of the long-term consequences of tobacco use. The aim of this study was to compare the direct medical costs of smoking cessation therapies with varenicline, bupropion, nicotine replacement therapy, and unaided cessation in Nicaragua over 5 time horizons: 2, 5, 10, and 20 years, and lifetime.
  
  
  METHODS
  The current annual costs of chronic obstructive pulmonary disease, lung cancer, coronary heart disease, and stroke were estimated based on the current annual incidence for each disease using 1 public hospital database (Hospital Lenin Fonseca, 2010). The Benefits of Smoking Cessation on Outcomes simulation model was used to obtain the projected direct costs for each strategy. An adult cohort (N = 3 639 948) from Nicaragua was used and the assessment was conducted using the health care payer's perspective. Costs were discounted at 5% annually. Probabilistic sensitivity analyses were conducted using a Monte Carlo second-order approach.
  
  
  RESULTS
  Varenicline is associated with the highest health care cost-savings compared with the other 3 alternatives at 5, 10, and 20 years, and lifetime. At lifetime, varenicline would result in savings of US$4 545 008, US$5 859 300, and US$11 033 221 when compared with bupropion, nicotine replacement therapy, and unaided cessation, respectively. Varenicline also avoided the highest number of smoking-related deaths in comparison with the alternatives. At year 10, varenicline avoided 96, 124, and 234 more deaths than bupropion, nicotine replacement therapy, and unaided cessation, respectively. The results of probabilistic sensitivity analyses support these findings.
  
  
  CONCLUSIONS
  The use of a smoking cessation therapy with varenicline would generate long-term savings to Nicaragua's health care institutions of > US$11 million in the lifetime time horizon.
authors.affiliation: Medical Manager and Outcomes Research Specialist, Pfizer Central America and the Caribbean, Escazú, Costa Rica. manfred.lutz@pfizer.com
authors.forename: Manfred A
authors.initials: MA
authors.lastname: Lutz
authors.forename: Pedro
authors.initials: P
authors.lastname: Lovato
authors.forename: Genaro
authors.initials: G
authors.lastname: Cuesta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001552:Benzazepines / Q000191:economics* / Q000627:therapeutic use; D016642:Bupropion / Q000191:economics* / Q000627:therapeutic use; D003327:Coronary Disease / Q000191:economics / Q000209:etiology; D003365:Costs and Cost Analysis; D018765:Dopamine Uptake Inhibitors / Q000191:economics* / Q000627:therapeutic use; D005102:Health Expenditures; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000209:etiology; D008875:Middle Aged; D009527:Nicaragua / Q000453:epidemiology; D018722:Nicotinic Agonists / Q000191:economics* / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000209:etiology; D011810:Quinoxalines / Q000191:economics* / Q000627:therapeutic use; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D020521:Stroke / Q000191:economics / Q000209:etiology; D013997:Time Factors; D061485:Tobacco Use Cessation Devices / Q000191:economics*; D000068580:Varenicline; D055815:Young Adult
chemical_list: D001552:Benzazepines; D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D011810:Quinoxalines; D016642:Bupropion; D000068580:Varenicline