Smoking cessation: an economic analysis and review of varenicline

Abstract

Despite efforts to decrease tobacco use, smoking continues to be a leading cause of preventable morbidity and premature death. The associated economic burden is substantial, both in the form of direct costs (healthcare expenditures) and indirect costs (lost productivity), regardless of whether the burden is assessed from the standpoint of an employer, a health plan, or society as a whole. Cessation programs are considered among the most cost-effective in healthcare, and are often used as a benchmark for other medical interventions. This analysis specifically considers the cost-effectiveness of varenicline, a novel α4β2 partial agonist used for smoking cessation, in comparison to other approved therapies. Clinical trial data have demonstrated that varenicline has the ability to decrease cravings and withdrawal symptoms, and lessen positive reinforcement associated with smoking. Varenicline’s novel mechanism has translated into superior efficacy in comparison to other available therapies. For this reason, despite an initial cost that typically exceeds that of other medications, varenicline is a cost-effective option for smoking cessation.

The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions

“…22; http://www.cypalleles.ki.se/cyp2a6.htm]. Reduced-activity and null mutations are associated with slower nicotine clearance (23)(24)(25) and are significantly more prevalent among nonsmokers compared with smokers, including within samples of European, Asian, and African descent (25)(26)(27)(28)(29). Among smokers, those with reduced-activity or null variants of CYP2A6 are less nicotine dependent (30,31), are more likely to smoke for shorter durations (28), and are more likely to quit smoking (32), compared with those with wild-type genotypes.…”

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

“…Varenicline has been shown to achieve better quit rates than NRTs and the non-nicotine-based drug, bupropion, which has been in use for some years [17,18]. In previous cost-effectiveness studies conducted in HICs, there seems to be a consistent pattern in which varenicline dominates other smoking cessation alternatives [30][31][32][33][34][35][36][37].…”

“…Although varenicline is typically the most expensive smoking cessation option when considering just treatment costs, its superiority in achieving long-term abstinence results in significant savings because it reduces morbidity and mortality, which would otherwise result in higher use of healthcare resources [31,66]. Patient acceptance of varenicline is high, and the novel partial agonist has been shown to decrease cravings and withdrawal symptoms and to blunt the positive reinforcement associated with smoking [67].…”

“…In addition, when we explored reviews of economic studies [30][31][32][33][34][35][36][37], we discovered that some of the existing reviews of economic assessment studies are undertaken without a systematic search strategy, and are out of date and merely provide descriptive summaries. The use of economic evaluation studies to inform decision-making has rapidly increased in recent decades across the world.…”

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

“…Prior cost-effectiveness analyses for varenicline differed from the current analysis in that they have (1) relied on efficacy results from clinical trials that compare varenicline with bupropion, nicotine replacement therapy, or placebo; (2) have utilized the Benefits of Smoking Cessation on Outcomes (BENESCO) simulation model (which reduces intervention costs by expected cost reductions from reduced incidence of smoking-related diseases); and (3) have calculated incremental cost-effectiveness (i.e., the net cost per additional quit) [48–50]. The current analysis is not directly comparable to those estimates since it uses real-world quit rates; all groups receive varenicline and consequently the comparison group is continuing smokers, and costs are exclusive of changes in medical costs (including both costs of smoking-related diseases and costs for medical services used as a result of additional years of life).…”