Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD
Open Access
- 13 March 2018
- Vol. 113, 65-75
- https://doi.org/10.1111/add.14090
Abstract
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.This publication has 45 references indexed in Scilit:
- Economic Evaluation of Cardio inCode®, a Clinical-Genetic Function for Coronary Heart Disease Risk AssessmentApplied Health Economics and Health Policy, 2013
- Smoking and health-related quality of life in English general population: implications for economic evaluationsBMC Public Health, 2012
- Brief opportunistic smoking cessation interventions: a systematic review and meta‐analysis to compare advice to quit and offer of assistanceAddiction, 2011
- Coste del asma en pediatría en España: un modelo de evaluación de costes basado en la prevalenciaAnales de Pediatría, 2011
- Propuesta de guía para la evaluación económica aplicada a las tecnologías sanitariasGaceta Sanitaria, 2010
- Avoidable global cancer deaths and total deaths from smokingNature Reviews Cancer, 2009
- Análisis coste-efectividad de vareniclina (Champix®) en el tratamiento del tabaquismo en EspañaAnales de Medicina Interna, 2008
- The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitlineTobacco Control, 2007
- Cost-effectiveness of pharmacotherapies for nicotine dependence in primary care settings: a multinational comparisonTobacco Control, 2006
- La mortalidad atribuible al tabaquismo comienza a descender en EspañaMedicina Clinica, 2005