title: Cost-effectiveness analysis of clinical smoking cessation interventions in Thailand.
abstract: OBJECTIVE
  Clinical smoking cessation interventions have been found typically to be highly cost-effective in many high-income countries. There is a need to extend this to low- and middle-income countries and undertake comparative analyses. This study aimed to estimate the incremental cost-effectiveness ratio of a range of clinical smoking cessation interventions available in Thailand.
  
  
  METHODS
  Using a Markov model, cost-effectiveness, in terms of cost per quality-adjusted life years (QALY) gained, from a range of interventions was estimated from a societal perspective for males and females aged 40 years who smoke at least 10 cigarettes per day. Interventions considered were: counselling in hospital, phone counselling (Quitline) and counselling plus nicotine gum, nicotine patch, bupropion, nortriptyline or varenicline. An annual discounting rate of 3% was used. Probabilistic sensitivity analyses were conducted and a cost-effectiveness acceptability curve (CEAC) plotted. Comparisons between interventions were conducted involving application of a 'decision rule' process.
  
  
  RESULTS
  Counselling with varenicline and counselling with nortriptyline were found to be cost-effective. Hospital counselling only, nicotine patch and bupropion were dominated by Quitline, nortriptyline and varenicline, respectively, according to the decision rule. When compared with unassisted cessation, probabilistic sensitivity analysis revealed that all interventions have very high probabilities (95%) of being cost-saving except for nicotine replacement therapy (NRT) patch (74%).
  
  
  CONCLUSIONS
  In middle-income countries such as Thailand, nortriptyline and varenicline appear to provide cost-effective clinical options for supporting smokers to quit.
authors.affiliation: International Health Policy Program, Nonthaburi, Thailand.
authors.forename: Jiraboon
authors.initials: J
authors.lastname: Tosanguan
authors.affiliation: School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.|Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.|School of Pharmacy, University of Wisconsin, Madison, USA.|School of Population Health, University of Queensland, Brisbane, Australia.
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D018722:Nicotinic Agonists / Q000191:economics / Q000627:therapeutic use; D009661:Nortriptyline / Q000191:economics / Q000627:therapeutic use; D011788:Quality of Life; D012907:Smoking / Q000191:economics*; D016540:Smoking Cessation / Q000191:economics*; D000074606:Smoking Prevention; D013785:Thailand; D061485:Tobacco Use Cessation Devices; D000068580:Varenicline / Q000191:economics / Q000627:therapeutic use
chemical_list: D018722:Nicotinic Agonists; D009661:Nortriptyline; D000068580:Varenicline
keywords: Bupropion; cost-effectiveness; cost-utility; counselling; nicotine gum; nicotine patch; nicotine replacement therapy; nortriptyline; smoking cessation; varenicline