title: Re-treatment with varenicline is a cost-effective aid for smoking cessation.
abstract: OBJECTIVE
  One quit attempt with varenicline has been found to be a cost-effective smoking cessation intervention. The purpose of this study was to analyze varenicline's cost-effectiveness in patients who relapse during or after the first treatment. A comparison was made between re-treatment schema with varenicline and re-treatment schema with bupropion, NRT and unaided cessation, and treatment once with varenicline in a Finnish context.
  
  
  METHODS
  The two-quit version of BENESCO Markov model was used to follow a cohort of smokers making up to two quit attempts over a lifetime. The abstinence rates of the interventions were derived from a Cochrane review. Gender- and age-specific data on the incidence and prevalence of five smoking-related diseases were included in the model. Quality-adjusted life-years, total expected costs, and the lifetime cumulative incidence of smoking-related morbidities and mortality were the primary outcomes evaluated.
  
  
  RESULTS
  The study cohort comprised 116,533 smokers who were willing to make a quit attempt. In the lifetime simulation, re-treatment with varenicline yielded 6,150-20,250 extra quitters, depending on the comparator. Among these quitters it was possible to prevent 899-2,972 additional cases of smoking-related diseases, and 395-1,307 deaths attributable to smoking. Re-treatment with varenicline resulted in cost savings of up to 54.9 million Euros. Re-treatment with varenicline dominated all the other smoking cessation interventions used in the analysis. Sensitivity analysis supported the robustness of the base case results.
  
  
  CONCLUSIONS
  The analysis did not consider adverse events, and included only five major smoking-related diseases, which is a conservative approach, and probably leads to under-estimation of cost-effectiveness of cessation interventions. Furthermore, assumptions of constant relative risks for smoking-related diseases for each smoking status and the proxy values used as efficacy estimates of second quit attempts for other interventions than varenicline are limitations.
  
  
  CONCLUSIONS
  A second quitting effort with varenicline is economically justifiable.
authors.affiliation: a Medaffcon Oy , Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Kautiainen
authors.affiliation: b Helsinki and Uusimaa hospital district (HUS), Porvoo Hospital , Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Ekroos
authors.affiliation: c University of Eastern Finland , Finland.|d Kuopio University Hospital , Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Puhakka
authors.affiliation: e University of Western Australia , Perth , Australia.
authors.forename: Helena
authors.initials: H
authors.lastname: Liira
authors.affiliation: f Pfizer Oy , Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Laine
authors.affiliation: f Pfizer Oy , Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Linden
authors.affiliation: a Medaffcon Oy , Finland.
authors.forename: Jarmo
authors.initials: J
authors.lastname: Hahl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000008:administration & dosage* / Q000191:economics*; D019233:Retreatment; D016540:Smoking Cessation; D000068580:Varenicline / Q000008:administration & dosage* / Q000191:economics*; D055815:Young Adult
chemical_list: D018722:Nicotinic Agonists; D000068580:Varenicline
keywords: Smoking cessation; cost-effectiveness; disease prevention; smoking related diseases; varenicline