The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles

Abstract

Objective:To examine the incremental cost effectiveness of the five first line pharmacological smoking cessation therapies in the Seychelles and other developing countries.Design:A Markov chain cohort simulation.Subjects:Two simulated cohorts of smokers: (1) a reference cohort given physician counselling only; (2) a treatment cohort given counselling plus cessation therapy.Intervention:Addition of each of the five pharmacological cessation therapies to physician provided smoking cessation counselling.Main outcome measures:Cost per life-year saved (LYS) associated with the five pharmacotherapies. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications.Results:Based on prices for currently available generic medications on the global market, the incremental cost per LYS for a 45 year old in the Seychelles was US$599 for gum and $227 for bupropion. Assuming US treatment prices as a conservative estimate, the incremental cost per LYS was significantly higher, though still favourable in comparison to other common medical interventions: $3712 for nicotine gum, $1982 for nicotine patch, $4597 for nicotine spray, $4291 for nicotine inhaler, and $1324 for bupropion. Cost per LYS increased significantly upon application of higher discount rates, which may be used to reflect relatively high opportunity costs for health expenditures in developing countries with highly constrained resources and high overall mortality.Conclusion:Pharmacological cessation therapy can be highly cost effective as compared to other common medical interventions in low mortality, middle income countries, particularly if medications can be procured at low prices.

The Hitchhiker's Guide to Tobacco Control: A Global Assessment of Harms, Remedies, and Controversies

“…Less is known about the cost-effectiveness of community interventions, but they may be comparable (115). Even in middle-income countries, cessation pharmacotherapy can be highly cost-effective compared with other medical interventions (50). Its costeffectiveness in low-income countries is not known.…”

Current Trends and Impact of Smoking Cessation Interventions for Adult Smokers in Low and Middle Income Countries: A Systematic Literature Review

“…Six studies assessed the effectiveness and cost-effectiveness of different smoking cessation interventions on adult smoking population (Jeremias et al, 2012;Higashi and Barendregt, 2011;Ward et al, 2012;Gilbert et al, 2004;Srivastava, Malhotra, Harries, Lal, and Arora, 2013;and Zhu et al, 2009). Four studies explored the reach, adoption, and institutionalisation of smoking cessation interventions in LMICs (Muller and Wehbe, 2008;Heydari et al, 2012;Raw, McNeill, and Murray, 2010;Pine-Abata et al, 2012).…”

Addressing Cardiovascular Disease Burden in low and Middle Income Countries (LMICs)

“…In Thailand, use of nicotine replacement therapy (NRT) showed increased likelihood of smoking cessation (OR=1.66). Also there was a 5 % increase in use of NRT by those who quit smoking [42,46]. Regular follow up and monitoring by trained health professionals are required for those who quit harmful practices of sustained tobacco and alcohol use.…”