Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD

  • Marta Trapero-Bertran /
  • Celia Muñoz /
  • Kathryn Coyle /
  • Doug Coyle /
  • Adam Lester-George /
  • Reiner Leidl /
  • Bertalan Németh /
  • Kei Long Cheung /
  • Subhash Pokhrel /
  • ángel Lopez-Nicolás
Journal ar
  • Volumen: 113
  • Fecha: 01 June 2018
  • Páginas: 65-75
  • ISSN: 13600443 09652140
  • Source Type: Journal
  • DOI: 10.1111/add.14090
  • Document Type: Article
  • Publisher: Blackwell Publishing Ltd
© 2018 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.Aims: To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). Design: We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life-time costs and benefits. Setting: Spain. Participants: Adult smoking population (16+ years). Measurements: Health-care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. Findings: The cost of implementing the current provision of smoking cessation services is approximately ¿61 million in the current year. This translates to 18 quitters per 1000 smokers and a life-time benefit¿cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generated more QALYs) from the life-time perspective, compared with the current provision. The life-time benefit¿cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. Conclusions: According to the EQUIPTMOD modelling tool it would be cost-effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro-active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run.

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