Abstract
Background: Relapse to smoking is a common challenge to many quitters, thus, access to effective smoking cessation treatment (SCT) for multiple quit attempts may be important in achieving permanent abstinence.
Objective: To evaluate the impact of access (V[+]) vs. no-access to varenicline (V[–]) on predicted health benefits and costs over smokers' lifetimes.
Methods: A discrete event simulation of SCT allowing multiple quit attempts (QA) with choice of treatments predicting response and possible relapse, as well as estimates of lifetime health and economic outcomes in a U.S. population was developed. The simulations compare outcomes of smokers who had access to varenicline for all QA's with those without any access to varenicline. Smokers could also use NRT, bupropion, behavioral modification, or “cold turkey” for any QA, regardless of access to varenicline.
Results: The average predicted total abstinence time (tAT) is 113 months with V[–] and 126 months with V[+]. The corresponding average lifetime QAs/smoker are 9.0 with V[–] and 7.5 with V[+] conditions. The percent of individuals achieving permanent abstinence (at least 2 years by the time of death) is 68% with V[–] and 72% with V[+]. For each simulated comorbidity (COPD, lung cancer, coronary heart disease and stroke), the incidence of new cases is lower with V[+]. Access to varenicline is dominant, i.e. more effective and less costly than no-access across all comparisons.
Conclusion: Providing access to varenicline over smokers' lifetimes results in better health outcomes at lower costs.
- © 2011 ERS