title: Cost-effectiveness analysis of varenicline versus existing smoking cessation strategies in Central America and the Caribbean using the BENESCO model.
abstract: OBJECTIVE
  In Central American countries, the economic burden of tobacco has not been assessed. In Costa Rica, a study demonstrated that tobacco-related diseases represent high costs for the health care system. The aim of this study was to assess the cost-effectiveness of varenicline compared with other existing strategies for smoking cessation within a 10-year time horizon in an adult population cohort from Central American and Caribbean countries using the health care payer's perspective.
  
  
  METHODS
  The Benefits of Smoking Cessation on Outcomes simulation model was used for an adult cohort in Costa Rica (n = 2 474 029), Panama (n = 2 249 676), Nicaragua (n = 3 639 948), El Salvador (n = 4 537 803), and the Dominican Republic (n = 6 528 125) (N = 19 429 581). Smoking cessation therapies compared were varenicline (0.5-2 mg/day) versus bupropion (300 mg/day), nicotine replacement therapy (5-15 mg/day), and unaided cessation. Effectiveness measures were: life-years (LYs) gained and quality-adjusted life-years (QALYs) gained. Resource use and cost data were obtained from a country's Ministry of Health and/or Social Security Institutions (2008-2010). The model used a 5% discount rate for costs (expressed in 2010 US$) and health outcomes. Probabilistic sensitivity analyses were conducted and acceptability curves were constructed.
  
  
  RESULTS
  Varenicline reduced smoking-related morbidity, mortality, and health care costs in each country included in the study. Accumulatively, mortality in the varenicline arm was reduced by 1190, 1538, and 2902 smoking-related deaths compared with bupropion, nicotine replacement therapy, and unaided cessation, respectively. The net average cost per additional quitter showed that varenicline was cost-saving when compared with competing alternatives. Regarding LYs and QALYs gained in 10 years, varenicline obtained the greatest number of QALYs and LYs in each country, while unaided cessation obtained the fewest. Cost-effectiveness analyses in all 5 countries showed that varenicline was the dominant strategy. Acceptability curves showed that, independent of the willingness to pay, the probability that varenicline is cost-effective was 99% for this region. The results of the probabilistic sensitivity analyses support the robustness of the findings.
  
  
  CONCLUSIONS
  Smoking cessation therapy with varenicline is cost-saving for the Central American and Caribbean countries included. These results could help to reduce the tobacco-related disease burden and align cost-containment policies.
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: D001552:Benzazepines / Q000191:economics* / Q000627:therapeutic use*; D016642:Bupropion / Q000191:economics / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology; D002489:Central America / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D004293:Dominican Republic / Q000453:epidemiology; D018765:Dopamine Uptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000209:etiology; 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; D019057:Quality-Adjusted Life Years; D011810:Quinoxalines / Q000191:economics* / Q000627:therapeutic use*; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods*; D061485:Tobacco Use Cessation Devices / Q000191:economics; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D011810:Quinoxalines; D016642:Bupropion; D000068580:Varenicline