title: Cost-effectiveness of varenicline versus bupropion, nicotine-replacement therapy, and unaided cessation in Greece.
abstract: BACKGROUND
  Varenicline was designed to relieve symptoms of nicotine withdrawal, including cigarette craving, and to block the reinforcing effects of continued nicotine use. The cost-effectiveness of varenicline in some countries has not been studied.
  
  
  OBJECTIVE
  The aim of this study was to compare the cost-effectiveness of varenicline to that of bupropion, nicotine-replacement therapy (NRT), and unaided cessation in the Greek health care setting. The analysis takes into account a societal security (third-party payer) perspective.
  
  
  METHODS
  To perform the analyses of the benefits of smoking cessation in terms of smoking-related morbidity, mortality, and associated medical costs, a Markov model was used that simulated the progress of a hypothetical cohort of current smokers making a single attempt to quit smoking at the beginning of the timeframe of the analysis. The robustness of the results was assessed using a series of 1-way sensitivity analyses.
  
  
  RESULTS
  Varenicline was associated with the potential prevention of 14.1, 14.2, and 35.1 additional cases of the 4 smoking-related diseases incorporated into the model, per 1000 smokers willing to quit, versus bupropion, NRT, and unaided cessation, respectively. Potentially avoided smoking-related deaths with varenicline were estimated at 3.24, 3.26, and 7.5 per 1000 quitters versus the 3 comparators. Varenicline led to a potential gain of 33.78, 33.91, and 83.97 QALYs per 1000 persons willing to make a quit attempt versus the 3 comparators. Varenicline was associated with cost-savings against both active comparators for the lifetime horizon. Overall, the cost per additional quitter with varenicline, considering only the costs of the smoking-cessation strategy, was €2659 (€1015) for a lifetime horizon compared with bupropion (NRT); however, when all direct costs were incorporated into the analysis, varenicline was cost-saving.
  
  
  CONCLUSIONS
  The findings from the present study suggest that, compared with the widely used treatment options bupropion and NRT, as well as unaided cessation, varenicline may enhance smoking-cessation treatment outcomes while substantially reducing the overall costs of smoking to the health care system.
authors: Department of Health Economics, National School of Public Health, Athens, Greece.
authors: Kostas
authors: K
authors: Athanasakis
authors: Michael
authors: M
authors: Igoumenidis
authors: Eleftheria
authors: E
authors: Karampli
authors: Elli
authors: E
authors: Vitsou
authors: Georgia
authors: G
authors: Sykara
authors: John
authors: J
authors: Kyriopoulos
mesh_terms: D001552:Benzazepines / Q000191:economics* / Q000627:therapeutic use*; D016642:Bupropion / Q000191:economics* / Q000627:therapeutic use*; D003198:Computer Simulation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006115:Greece / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008390:Markov Chains; D018803:Models, Economic; D009010:Monte Carlo Method; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D011810:Quinoxalines / Q000191:economics* / Q000627:therapeutic use*; D012907:Smoking / Q000191:economics* / Q000401:mortality; D016540:Smoking Cessation / Q000191:economics*; D000074606:Smoking Prevention; D013997:Time Factors; D061485:Tobacco Use Cessation Devices / Q000191:economics*; D014029:Tobacco Use Disorder / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D011810:Quinoxalines; D016642:Bupropion; D000068580:Varenicline