Madae'en Saba, Obeidat Nour, Adeinat Mohammad
Department of Biopharmaceutical and Clinical Pharmacy, University of Jordan, Amman, 11941 Jordan.
King Hussein Cancer Centre, Amman, Jordan.
J Pharm Policy Pract. 2020 Oct 27;13:65. doi: 10.1186/s40545-020-00270-y. eCollection 2020.
Smoking cessation pharmacotherapies (SCPs) have been established as cost-effective for the treatment of tobacco use disorder across a variety of settings. In Jordan, a resource-constrained country where smoking rates rank at one of the highest globally, the cost-effectiveness of SCPs has not yet been quantified. The lack of information about the value of SCPs has contributed to low demand for them (from public and private payers) and consequently low availability of these medications. The aim of this study was to simulate-in a hypothetical cohort of Jordanian smokers-the clinical and economic impact of using two smoking cessation regimens and to generate cost-effectiveness values that can support policy changes to avail smoking cessation medication in a country burdened with heavy tobacco use.
We employed a similar approach to a widely used economic model, the Benefits of Smoking Cessation on Outcomes (BENESCO) model. A hypothetical cohort of Jordanian male smokers aged 30 to 70 years and making a quit attempt using either a varenicline regimen or a nicotine replacement therapy (NRT) regimen were followed over time (until reaching 70 years of age). Markov simulations were run for the cohort, and life years gained were computed for each arm (compared to no intervention). Drug costs, prevalence of smoking, and population life expectancies were based on Jordanian data. Efficacy data were obtained from the literature. Incremental cost-effectiveness ratios as well as the potential budgetary impact of employing these regimens were generated. Several parameters were modified in sensitivity analyses to capture potential challenges unique to Jordan and that could impact the results.
For a treatment cohort of 527,118 Jordanian male smokers who intended to quit, 103,970 life years were gained using the varenicline regimen, while 64,030 life years were gained using the NRT regimen (compared to the no-intervention arm of life years). The cost per life year gained was JD1204 ($1696 USD) and JD1342 ($1890 USD) for varenicline and NRT, respectively.
戒烟药物疗法（SCPs）已被证明在各种环境下治疗烟草使用障碍具有成本效益。在约旦这个资源有限且吸烟率位居全球最高之列的国家，SCPs的成本效益尚未得到量化。关于SCPs价值的信息匮乏导致（公共和私人支付方）对其需求较低，进而这些药物的可及性也较低。本研究的目的是在一个假设的约旦吸烟者队列中模拟使用两种戒烟方案的临床和经济影响，并生成成本效益值，以支持政策变革，使在一个烟草使用负担沉重的国家能够获得戒烟药物。
我们采用了与广泛使用的经济模型——戒烟对结果的益处（BENESCO）模型类似的方法。对一个假设的年龄在30至70岁之间、尝试使用伐尼克兰方案或尼古丁替代疗法（NRT）方案戒烟的约旦男性吸烟者队列进行长期跟踪（直至70岁）。对该队列进行马尔可夫模拟，并计算每个组（与不干预相比）获得的生命年数。药物成本、吸烟率和人口预期寿命基于约旦的数据。疗效数据从文献中获取。生成了增量成本效益比以及采用这些方案的潜在预算影响。在敏感性分析中对几个参数进行了修改，以捕捉约旦特有的、可能影响结果的潜在挑战。
对于一个有527,118名打算戒烟的约旦男性吸烟者的治疗队列，使用伐尼克兰方案获得了103,970个生命年，而使用NRT方案获得了64,030个生命年（与生命年的不干预组相比）。伐尼克兰和NRT每获得一个生命年的成本分别为1204约旦第纳尔（1696美元）和1342约旦第纳尔（1890美元）。
