Hoogendoorn Martine, Welsing Paco, Rutten-van Mölken Maureen P M H
Institute for Medical Technology Assessment (iMTA), Erasmus MC, Rotterdam, The Netherlands.
Curr Med Res Opin. 2008 Jan;24(1):51-61. doi: 10.1185/030079908x242917.
To examine the cost-effectiveness of varenicline, a new pharmacotherapy to support smoking cessation, compared with the currently available pharmacologic alternatives in the Netherlands.
The BENESCO-model was used to estimate the long-term health and economic benefits of smoking cessation for a cohort of smokers making a one-time quit attempt. The cohort represented the population of Dutch smokers with respect to gender, age, and prevalence of the smoking-related diseases included in the model: COPD, lung cancer, CHD, stroke, and asthma exacerbations. The model compared the cumulative incidence of smoking-related diseases, (quality-adjusted) life years, intervention costs, and direct medical costs between the cohort treated with varenicline and the same cohort either untreated (unaided cessation) or treated with bupropion, nortriptyline or NRT. The time horizon was lifetime. Future costs were discounted at 4%, health outcomes at 1.5%.
The cost of varenicline per additional quitter ranged from 1030 Euro compared with NRT to 4270 Euro compared with nortriptyline. When including the savings due to the reduction in incidence of smoking-related diseases, varenicline generated net savings compared with bupropion and NRT. Compared with nortriptyline and unaided cessation, varenicline was estimated to cost 1650 Euro/QALY and 320 Euro/QALY gained, respectively. At a willingness-to-pay as low as 5000/QALY gained, the probability that varenicline was cost-effective was more than 80% compared to bupropion, NRT, and unaided cessation and about 60% compared to nortriptyline.
Treatment with varenicline for smoking cessation is cost-effective compared with nortriptyline and unaided cessation and even cost-saving compared with bupropion and NRT.
与荷兰目前可用的药物戒烟替代品相比，评估伐尼克兰（一种支持戒烟的新型药物疗法）的成本效益。
使用BENESCO模型估算一组一次性尝试戒烟的吸烟者戒烟带来的长期健康和经济效益。该队列在性别、年龄以及模型中纳入的吸烟相关疾病（慢性阻塞性肺疾病、肺癌、冠心病、中风和哮喘加重）患病率方面代表了荷兰吸烟者群体。该模型比较了接受伐尼克兰治疗的队列与未接受治疗（自主戒烟）或接受安非他酮、去甲替林或尼古丁替代疗法（NRT）治疗的同一队列之间吸烟相关疾病的累积发病率、（质量调整）生命年、干预成本和直接医疗成本。时间跨度为终身。未来成本按4%贴现，健康结果按1.5%贴现。
每增加一名戒烟者，伐尼克兰的成本与NRT相比为1030欧元，与去甲替林相比为4270欧元。若将因吸烟相关疾病发病率降低而节省的费用计算在内，与安非他酮和NRT相比，伐尼克兰产生了净节省。与去甲替林和自主戒烟相比，估计伐尼克兰每获得一个质量调整生命年（QALY）的成本分别为1650欧元和320欧元。在每获得一个QALY的支付意愿低至5000欧元时，与安非他酮、NRT和自主戒烟相比，伐尼克兰具有成本效益的概率超过80%，与去甲替林相比约为60%。
与去甲替林和自主戒烟相比，使用伐尼克兰治疗戒烟具有成本效益，与安非他酮和NRT相比甚至具有成本节省效益。
