Lutz Manfred A, Lovato Pedro, Cuesta Genaro
Medical Manager and Outcomes Research Specialist, Pfizer Central America and the Caribbean, Escazú, Costa Rica.
Hosp Pract (1995). 2012 Feb;40(1):24-34. doi: 10.3810/hp.2012.02.945.
In Central American countries, the economic burden of tobacco has not been assessed. In Costa Rica, a study demonstrated that tobacco-related diseases represent high costs for the health care system. The aim of this study was to assess the cost-effectiveness of varenicline compared with other existing strategies for smoking cessation within a 10-year time horizon in an adult population cohort from Central American and Caribbean countries using the health care payer's perspective.
The Benefits of Smoking Cessation on Outcomes simulation model was used for an adult cohort in Costa Rica (n = 2 474 029), Panama (n = 2 249 676), Nicaragua (n = 3 639 948), El Salvador (n = 4 537 803), and the Dominican Republic (n = 6 528 125) (N = 19 429 581). Smoking cessation therapies compared were varenicline (0.5-2 mg/day) versus bupropion (300 mg/day), nicotine replacement therapy (5-15 mg/day), and unaided cessation. Effectiveness measures were: life-years (LYs) gained and quality-adjusted life-years (QALYs) gained. Resource use and cost data were obtained from a country's Ministry of Health and/or Social Security Institutions (2008-2010). The model used a 5% discount rate for costs (expressed in 2010 US$) and health outcomes. Probabilistic sensitivity analyses were conducted and acceptability curves were constructed.
Varenicline reduced smoking-related morbidity, mortality, and health care costs in each country included in the study. Accumulatively, mortality in the varenicline arm was reduced by 1190, 1538, and 2902 smoking-related deaths compared with bupropion, nicotine replacement therapy, and unaided cessation, respectively. The net average cost per additional quitter showed that varenicline was cost-saving when compared with competing alternatives. Regarding LYs and QALYs gained in 10 years, varenicline obtained the greatest number of QALYs and LYs in each country, while unaided cessation obtained the fewest. Cost-effectiveness analyses in all 5 countries showed that varenicline was the dominant strategy. Acceptability curves showed that, independent of the willingness to pay, the probability that varenicline is cost-effective was 99% for this region. The results of the probabilistic sensitivity analyses support the robustness of the findings.
Smoking cessation therapy with varenicline is cost-saving for the Central American and Caribbean countries included. These results could help to reduce the tobacco-related disease burden and align cost-containment policies.
在中美洲国家，烟草的经济负担尚未得到评估。在哥斯达黎加，一项研究表明，与烟草相关的疾病给医疗保健系统带来了高昂成本。本研究的目的是从医疗保健支付方的角度，评估在10年时间范围内，伐尼克兰与其他现有的戒烟策略相比，对中美洲和加勒比国家成年人群队列的成本效益。
使用戒烟对结局的益处模拟模型，对哥斯达黎加（n = 2474029）、巴拿马（n = 2249676）、尼加拉瓜（n = 3639948）、萨尔瓦多（n = 4537803）和多米尼加共和国（n = 6528125）的成年队列（N = 19429581）进行分析。比较的戒烟疗法为伐尼克兰（0.5 - 2毫克/天）与安非他酮（300毫克/天）、尼古丁替代疗法（5 - 15毫克/天）以及自行戒烟。有效性指标为：获得的生命年数（LYs）和质量调整生命年数（QALYs）。资源使用和成本数据来自各国卫生部和/或社会保障机构（2008 - 2010年）。该模型对成本（以2010年美元表示）和健康结局采用5%的贴现率。进行了概率敏感性分析并构建了可接受性曲线。
伐尼克兰降低了研究中每个国家与吸烟相关的发病率、死亡率和医疗保健成本。累计而言，与安非他酮、尼古丁替代疗法和自行戒烟相比，伐尼克兰组的死亡率分别减少了1190例、1538例和2902例与吸烟相关的死亡。每增加一名戒烟者的净平均成本表明，与竞争替代方案相比，伐尼克兰具有成本节约优势。关于10年内获得的LYs和QALYs，伐尼克兰在每个国家获得的QALYs和LYs数量最多，而自行戒烟获得的最少。所有5个国家的成本效益分析表明，伐尼克兰是主导策略。可接受性曲线显示，无论支付意愿如何，该地区伐尼克兰具有成本效益的概率为99%。概率敏感性分析结果支持了研究结果的稳健性。
对于所纳入的中美洲和加勒比国家，使用伐尼克兰进行戒烟治疗具有成本节约效益。这些结果有助于减轻与烟草相关的疾病负担，并使成本控制政策保持一致。
