Cost-effectiveness of varenicline and three different behavioral treatment formats for smoking cessation

Javitz, Harold S.; Zbikowski, Susan M.; Deprey, Mona; McAfee, Tim; McClure, Jennifer B.; Richards, Julie; Catz, Sheryl L.; Jack, Lisa M.; Swan, Gary E.

doi:10.1007/s13142-010-0009-8

Cited by 23 publications

(20 citation statements)

References 58 publications

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“…The 61% respondent and 38% ITT penalised imputation (missing=smoking) 30-day point prevalence quit rates at 6 months in the standard treatment group indicated that tobacco users who receive a multiple-call phone counselling programme, have access to cessation medication benefits, and successfully achieve at least a 24 h abstinence period early in treatment do quite well. These quit rates are high compared to studies focusing on all commercial quitline enrolees (eg, 34.3–41.1% responder quit rate at 6 months 27 28 ). The relatively strong performance and engagement in standard treatment for this study may have made achieving improvements with a low intensity relapse prevention intervention even more challenging.…”

Section: Discussionmentioning

confidence: 74%

A randomised controlled trial to prevent smoking relapse among recently quit smokers enrolled in employer and health plan sponsored quitlines

et al. 2015

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ObjectiveTo test adding an interactive voice response (IVR)-supported protocol to standard quitline treatment to prevent relapse among recently quit smokers.DesignParallel randomised controlled trial with three arms: standard quitline, standard plus technology enhanced quitline with 10 risk assessments (TEQ-10), standard plus 20 TEQ assessments (TEQ-20).SettingQuit For Life (QFL) programme.Participants1785 QFL enrolees through 19 employers or health plans who were 24+ h quit.InterventionsQFL is a 5-call telephone-based cessation programme including medications and web-based support. TEQ interventions included 10 or 20 IVR-delivered relapse risk assessments over 8 weeks with automated transfer to counselling for those at risk.Main outcome measuresSelf-reported 7-day and 30-day abstinence assessed at 6-month and 12-month post-enrolment (response rates: 61% and 59%, respectively). Missing data were imputed.Results1785 were randomised (standard n=592, TEQ-10 n=602, TEQ-20 n=591). Multiple imputation-derived, intent-to-treat 30-day quit rates (95% CI) at 6 months were 59.4% (53.7% to 63.8%) for standard, 62.3% (57.7% to 66.9%) for TEQ-10, 59.4% (53.7% to 65.1%) for TEQ-20 and 30-day quit rates at 12 months were 61.2% (55.6% to 66.8%) for standard, 60.6% (56.0% to 65.2%) for TEQ-10, 54.9% (49.0% to 60.9%) for TEQ-20. There were no significant differences in quit rates. 73.3% of TEQ participants were identified as at-risk by IVR assessments; on average, participants completed 0.41 IVR-transferred counselling calls. Positive risk assessments identified participants less likely (OR=0.56, 95% CI 0.42 to 0.76) to be abstinent at 6 months.ConclusionsStandard treatment was highly effective, with 61% remaining abstinent at 12 months using multiple imputation intent-to-treat (intent-to-treat missing=smoking quit rate: 38%). TEQ assessments identified quitters at risk for relapse. However, adding IVR-transferred counselling did not yield higher quit rates. Research is needed to determine if alternative designs can improve outcomes.Trial registration numberNCT00888992.

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Section: Discussionmentioning

confidence: 74%

A randomised controlled trial to prevent smoking relapse among recently quit smokers enrolled in employer and health plan sponsored quitlines

et al. 2015

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“…Our study ICER of $2316 per additional smoker who quit for Medicaid recipients is similar to the cost-effectiveness of other tobacco use treatment options for smokers in general populations. For example, the ICER for varenicline combined with proactive telephone counseling has been estimated at $2600 per additional smoker who quits [40]. Our ICER results illustrate that incentivizing engagement with treatment counselors is a viable Fig.…”

Section: Discussionmentioning

confidence: 77%

Paying Low-Income Smokers to Quit? The Cost-Effectiveness of Incentivizing Tobacco Quit Line Engagement for Medicaid Recipients Who Smoke

et al. 2019

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To determine the cost-effectiveness of an incentivebased stop-smoking intervention that paid Medicaid recipients who smoke to take calls from a tobacco quit line. Methods: A costeffectiveness analysis was conducted alongside a randomized controlled trial. The analysis was conducted from a health care systems perspective on the basis of costs and effectiveness over a 6month follow-up. Participants (n ¼ 1900) were recruited from May 2013 to June 2015 through quit line (n ¼ 980), clinic-based (n ¼ 444), or community-based (n ¼ 476) referrals. Incentive group participants (n ¼ 948) received $30 a call for taking up to five tobacco quit line calls and $40 for biochemically verified tobacco abstinence at 6 months. Control group participants (n ¼ 952) did not receive financial incentives for taking quit line calls. Intervention resource costs included incentive payments to participants, counselor and administrative staff time, and smoking cessation medications. Smoking status at baseline and 6 months was determined for all study participants via carbon monoxide (CO) breath tests (abstinence: CO < 7 ppm). Cost-effectiveness analysis calculated the incremental cost-effectiveness ratio (ICER). Results: Incentive treatment produced higher 6-month CO-confirmed 7-day point-prevalence abstinence than did the control treatment (21.6 vs. 13.8%; P < 0.001). The ICER of the financial incentives intervention was $2316 (95% confidence interval $1582e$4270) per additional person who quit. The study ICER compares favorably with other smoking treatments, such as varenicline combined with proactive telephone counseling, whose ICER has been estimated at $2600 per additional smoker who quits. Conclusions: Use of financial incentives to engage with tobacco quit line treatment is a cost-effective option to enhance smoking cessation rates for low-income smokers.

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“…Approximately 1 in 6 life-long smokers will die from lung cancer, and death from premature heart disease is about 1 in 2 [41,42]. The quality adjusted life year for smoking cessation is less than $1500 [43]. If the cost of CT screening high-risk, current smokers is prohibitive, then it may be appropriate, in regard of cost effectiveness, to require smoking cessation prior to the pursuit of CT screening.…”

Section: Discussionmentioning

confidence: 99%

Early diagnosis of lung cancer

Midthun¹

2013

F1000Prime Rep

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A large randomized controlled trial, The National Lung Screening Study (NLST), has demonstrated that screening with low-dose spiral computed tomography saved lives from lung cancer when compared with screening with chest radiographs. This is the first test showing efficacy in screening for lung cancer as previous trials of chest radiographs and sputum cytology failed to result in fewer deaths with screening. This review will examine the problem of lung cancer, the issues presented by screening, and the results of computed tomography (CT) studies for lung cancer screening. Now that CT screening has been shown to be effective, implementation of screening becomes the next step.

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Cost-effectiveness of varenicline and three different behavioral treatment formats for smoking cessation

Cited by 23 publications

References 58 publications

A randomised controlled trial to prevent smoking relapse among recently quit smokers enrolled in employer and health plan sponsored quitlines

A randomised controlled trial to prevent smoking relapse among recently quit smokers enrolled in employer and health plan sponsored quitlines

Paying Low-Income Smokers to Quit? The Cost-Effectiveness of Incentivizing Tobacco Quit Line Engagement for Medicaid Recipients Who Smoke

Early diagnosis of lung cancer

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