Cost-Effectiveness of Varenicline versus all Interventions for Quitting Smoking Cessation in the Adult Population of Costa Rica using the BENESCO Model

Abstract

Aim: Smoking is one of the most serious health problems worldwide and it is a preventable addiction; this is why the availability of treatments to quit smoking represents important benefits to each individual's health as well as to the institutional systems. Given the arrival of new treatments, especially Varenicline, the alternatives available in Costa Rica must be evaluated comparatively because it is not clear which therapeutic option is the best. The objective of this study is to model the cost-effectiveness of the therapeutic options for smoking cessation available in Costa Rica using the BENESCO model.
Methods: The BENESCO model was used to simulate the morbidity and mortality of the smoking population of Costa Rica, in both genders, between 18 and 99 years old. In this model, each smoker makes only one attempt to quit smoking at the beginning of the simulation. The strategies to quit smoking that were compared were: Varenicline, Bupropion, Nicotine replacement therapy, self determination cessation and motivational talks. The diseases related to smoking that were included were: Coronary heart disease, chronic obstructive pulmonary disease, stroke and lung cancer. The prevalence, annual incidence and mortality were obtained and calculated from the Costa Rica Social Security data base and the Institute of Alcoholism and Pharmacodependence of Costa Rica. The costs of the diseases were calculated and updated to September, 2008. Deterministic and probabilistic sensitivity analyses were conducted.
Results: Of all the strategies for smoking cessation, Varenicline was the therapeutic alternative that obtained less mortality and morbility in the years studied with the model. Regarding costs, Varenicline was also the less expensive option from the fifth year. On the second year, motivational talks were ¢3.443.167 less expensive than Varenicline. The intervention that obtained the largest number of Quality-adjusted life years and Life years gained was Varenicline. Varenicline was the most effective option in the cost-incremental analysis, this means, it was clinically more effective and less expensive.
Conclusion: The results obtained suggests that Varenicline is the most cost-effective intervention for smoking cessation in comparison with Bupropion, NRT, unaided cessation and motivational talks. It was proven that the use of Varenicline represents an important economic savings for the health system and the heath institutes that use it since it reduces morbidity and the costs related to the associated-smoking diseases.