Cost-Effectiveness Analysis of Smoking Cessation Interventions in Japan Using a Discrete-Event Simulation

Abstract

BackgroundSmoking cessation medications have been shown to yield higher success rates and sustained abstinence than unassisted quit attempts. In Japan, the treatments available include nicotine replacement therapy (NRT) and varenicline; however, unassisted attempts to quit smoking remain common.ObjectiveThe objective of this study was to compare the health and economic consequences in Japan of using pharmacotherapy to support smoking cessation with unassisted attempts and the current mix of strategies used.MethodsA discrete-event simulation that models lifetime quitting behaviour and includes multiple quit attempts (MQAs) and relapses was adapted for these analyses. The risk of developing smoking-related diseases is estimated based on the duration of abstinence. Data collected from a survey conducted in Japan were used to determine the interventions selected by smokers initiating a quit attempt and the time between MQAs. Direct and indirect costs are assessed (expressed in 2014 Japanese Yen).ResultsUsing pharmacotherapy (NRT or varenicline) to support quit attempts proved to be dominant when compared with unassisted attempts or the current mix of strategies (most are unassisted). The results of stratified analyses by age imply that smoking cessation improves health outcomes across all generations. Indirect costs due to premature death leading to lost wages are an important component of the total costs, exceeding the direct medical cost estimates.ConclusionsIncreased utilisation of smoking cessation pharmacotherapy to support quit attempts is predicted to lead to an increase in the number of smokers achieving abstinence, and provide improvements in health outcomes over a lifetime with no additional costs.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-015-0204-3) contains supplementary material, which is available to authorized users.

Examining the association of smoking with work productivity and associated costs in Japan

“…Moreover, some proportion of quitters in the study may have relapsed, but we did not analyze the duration of time since quitting. Igarashi et al 35 found that a longer duration of time since quitting smoking is associated with greater health benefits. However, we can conclude that quitting smoking is associated with workplace benefits, given that former and never smokers are statistically indistinguishable in terms of their work productivity loss and costs incurred.…”

“…Smoking cessation programs, including pharmacotherapy and behavioral interventions, have been found to both promote a healthy workforce and to be cost-effective when implemented in work-place settings [37][38][39][40] . A recent Japanese simulation-based study encouraged implementation of pharmacotherapy interventions for smoking cessation, stating that such programming could promote greater success among quitters, and would be associated with cost-savings once indirect and direct costs were considered 35 . Further, a randomized controlled trial of a smoking cessation counseling intervention at a worksite in Japan reported positive results, reducing smoking rates by 8.4% 41 .…”

Efficacy of the Ascure Smoking Cessation Program: Retrospective Study

“…There are more than 20 million smokers in Japan, and deaths from smoking-related diseases are estimated to exceed 12,900 annually [ 3 ]. Smoking cessation can greatly contribute to extending a healthy life span and the reduction of medical expenses [ 3 , 4 ]. In Japan, smoking cessation is mainly encouraged through outpatient services.…”

Enabling better management of patients: discrete event simulation combined with the STAR approach

“…Other DES models were also developed for similar purposes. Igarashi et al (2016) compared the health and economic consequences in Japan of using pharmacotherapy to support smoking cessation with unassisted attempts and the current mix of strategies used. According to their findings, increased utilisation of smoking cessation pharmacotherapy to support quit attempts is predicted to provide improvements in health outcomes over a lifetime with no additional costs.…”