Cost-Effectiveness Analysis of Smoking Cessation Interventions With Behavioral Support: A Study Based on the Benefits of Smoking Cessation on Outcomes (BENESCO) Model

Abstract

Introduction Few studies have compared cost-effectiveness between different smoking cessation interventions (SCIs) that include behavioral support, considering smoking-related diseases. Therefore, we compare the cost-effectiveness between SCIs with behavioral support in South Korea using the Benefits of Smoking Cessation on Outcomes (BENESCO) model. Methods We used the BENESCO model to estimate the cost and utility of the SCIs with behavioral support, including pharmacist counseling with nicotine replacement therapy (pharmacist+NRT), expert counseling with NRT (expert+NRT), and expert counseling with varenicline (expert+varenicline). The target population was adult smokers who wanted to cease smoking within 1 month. We applied transitional probabilities and epidemiological data from the literature. Medical costs and utilities were calculated using claims and national survey data, respectively. Cost-effectiveness was evaluated within the threshold (17,926 USD per quality-adjusted life years [QALYs]) by incremental cost-effectiveness ratio (ICER). Results The model cohort included 1,219,390 male and 298,511 female smokers. The pharmacist+NRT group had 32,842 more QALYs gained and 26,689,958 USD less expended than the expert+NRT group. The ICER for the expert+varenicline group versus the pharmacist+NRT and expert+NRT groups was 27,247 and 4,074 USD per QALY, respectively. The robustness of the results was confirmed by sensitivity analyses, except for the discount rate and cost of the expert+varenicline group. Conclusions In Korea, pharmacist counseling with NRT showed higher QALY gains and lower costs than expert counseling with NRT. Expert counseling with varenicline was more effective for smoking cessation and more cost-effective than expert counseling with NRT but was not cost-effective compared to pharmacist counseling with NRT. Implications This study provides evidence for decision-making on smoking cessation programs by evaluating the cost-effectiveness of SCIs. Furthermore, we attempted to use the BENESCO model to compare and evaluate the cost-effectiveness of SCIs with behavioral support. It is meaningful because this study showed the availability of using the BENESCO model in the future cost-effectiveness analysis of various SCIs.

Incremental net monetary benefit of using varenicline for smoking cessation: A systematic review and meta‐analysis of economic evaluation studies

“…Of the 1451 identified studies, 18 studies [17, 18, 21, 23, 25–28, 56–65] were eligible for the meta‐analysis (Figure 1), including 48 comparisons; varenicline versus bupropion (N = 14, C = 15) [17, 18, 21, 23, 25–28, 56, 57, 59, 60, 63, 64], varenicline versus NRT (N = 13, C = 17) [17, 18, 21, 25–28, 56, 58–60, 63, 65], varenicline versus behavioural support interventions alone (N = 5, C = 6) [17, 26, 59, 62, 64] and varenicline versus unaided cessation (N = 10, C = 11) [17, 18, 21, 23, 25, 26, 28, 56, 60, 61].…”

“…Sixteen studies [17, 18, 21, 23, 25, 27, 28, 56–58, 60–65] were performed in HICs, whereas two studies [26, 59] were conducted in LMICs. The majority of studies [17, 18, 21, 23, 25, 28, 56–60, 63–65] (72.22%) used the benefits of smoking cessation on outcomes (BENESCO) model, although others [26, 27, 61, 62] used alternative models such as a discrete‐event simulation or the European study on quantifying utility of investment in protection from tobacco model (EQUIPTMOD). The healthcare provider/payer perspective was most commonly chosen as the perspective of the studies.…”

“…Time horizon ranged from 10 years to lifetime. Of 18 studies with 48 comparisons, two studies [17, 26] compared four comparisons including bupropion, NRT, behaviour intervention and unaided cessation; seven studies [18, 21, 25, 28, 56, 59, 60] compared three comparisons; four studies [23, 27, 63, 64] compared two comparisons; and five studies [57, 58, 61, 62, 65] compared one comparison (Table 1 and Appendix S5).…”

“…Of the complete set of 18 studies, three of them adhered to scenario 4, whereas the remaining 15 studies followed scenario 5. Sixteen studies [17,18,21,23,25,27,28,[56][57][58][60][61][62][63][64][65] were performed in HICs, whereas two studies [26,59] were conducted in LMICs. The majority of studies [17,18,21,23,25,28,[56][57][58][59][60][63][64][65] (72.22%) used the benefits of smoking cessation on outcomes (BENESCO) model, although others [26,27,61,62] used alternative models such as a discrete-event simulation or the European study on quantifying utility of investment in protection from tobacco model (EQUIPTMOD).…”

“…In the majority of studies, reporting and dissemination bias, as well as bias related to internal consistency, were rated as unclear. Seven studies classified as low risk of bias (38.89%) [18,21,23,26,59,60,63], nine studies classified as moderate risk of bias (50.00%) [17,25,27,28,57,58,61,64,65] and two studies classified as high risk of bias (11.11%) (Appendix S6) [56,62].…”