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(searched for: doi:10.4321/s0212-71992008000700006)
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, Allison Jane Carroll, , Linda Catherine O'dwyer, Neil Jordan, , Lucy Ann Bilaver, Megan Colleen McHugh, Robert Murphy
Published: 21 August 2018
Addiction, Volume 114, pp 620-635; https://doi.org/10.1111/add.14518

Abstract:
Aims To summarize evidence for the efficacy of smoking cessation interventions in low‐ and middle‐income countries (LMICs). Design Systematic review and meta‐analysis of randomized controlled trials Setting LMICs as defined by the World Bank Participants Adult current cigarette smokers residing in LMICs Interventions Behavioral and/or pharmacotherapy smoking cessation interventions. Measurements PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception through 4/4/2018. Only studies with at least 6 months of follow‐up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta‐analysis was done using Mantel‐Haenzel random effect models reporting odds ratios (OR) and 95% confidence interval (CI). Findings Twenty‐four randomized controlled trials were included. Six investigated the efficacy of pharmacologic agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n=1230, OR 1.76, 95% CI 1.30‐2.77, P<0.001, I2= 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g., brief advice); n=5,735, OR 6.87, 95% CI 4.18‐11.29, P<0.001, I2= 67%). There was also evidence of the benefit of brief advice over usual care (n=728, OR 2.46, 95% CI 1.56‐3.88, P< 0.001, I2 =0%). Conclusion Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low‐ and middle‐income countries. There is limited rigorous research on other smoking cessation interventions in these regions.
, Celia Muñoz, Kathryn Coyle, Doug Coyle, Adam Lester-George, Reiner Leidl, , Kei-Long Cheung, Subhash Pokhrel, Ángel Lopez-Nicolás
Published: 13 March 2018
Addiction, Volume 113, pp 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.
The European Journal of Health Economics, Volume 19, pp 747-756; https://doi.org/10.1007/s10198-017-0919-1

Abstract:
The economic evaluation of tobacco control policies requires the adoption of assumptions about the impact of changes in smoking status on health-related quality of life (HRQoL). Estimates for such impacts are necessary for different populations. This paper aims to test whether smoking status has an independent effect on HRQoL over and above the effect derived from the increased likelihood of suffering a tobacco related disease, and to calculate utility values for the Spanish population.
Gholamreza Heydari
International Journal of Preventive Medicine, Volume 8; https://doi.org/10.4103/ijpvm.ijpvm_375_16

Abstract:
Background: Providing smoking cessation services are special importance to tobacco control programs. To date, Champix is a new expensive medication for smoking cessation available nationally. Champix has both agonist and antagonist activities and can reduce nicotine dependence and withdrawal symptoms. The purpose of this study was to evaluate the duration of using Champix based on its cost. Methods: This quasi-experimental study was conducted with smokers presenting to the Tanaffos Smoking Cessation Clinic in Tehran, Iran 2016. Smokers were visited by a physician 3 times at 1-week intervals for counseling. Smokers started to use Champix and stopped smoking in the 2nd week of counseling and were followed up by phone and through regular visits to the clinic at 1, 3, and 6 months postintervention. Some of them did not continue medication for 12 weeks because of its cost. Results: A total of 227 smokers including 133 males (58%) with a mean age of 43 years were enrolled of whom 116 (51.1%), 89 (43.6%), and 34 (20.6%) had quit smoking after 1, 3, and 6 months, respectively. Quit rates were significantly higher among those who used Champix for more than 6 weeks, and this rate was not correlated with age, sex, educational level, or nicotine dependence. Conclusions: Use of Champix for more than 6 weeks increases the quitting success rate compared with using for a shorter time. The cost of Champix was important for smokers and adding Champix to the list of insurance medication or getting it free of charge is needed.
, Carlos A Jiménez-Ruiz, Javier Rejas, Segismundo Solano-Reina, Jose Javier Lorza-Blasco, Juan Antonio Riesco-Miranda, M Barrueco-Ferrero, Neus Altet-Gomez, Jose Ignacio Granda-Orive, Eva de Higes-Martinez, et al.
International Journal of Chronic Obstructive Pulmonary Disease, Volume 10, pp 2027-2036; https://doi.org/10.2147/copd.s87597

Abstract:
Budgetary impact analysis on funding smoking-cessation drugs in patients with COPD in Spain Carlos A Jiménez-Ruiz,1 Segismundo Solano-Reina,2 Jaime Signes-Costa,3 Eva de Higes-Martinez,4 José I Granda-Orive,5 José J Lorza-Blasco,6 Juan A Riesco-Miranda,7 Neus Altet-Gomez,8 Miguel Barrueco,9 Itziar Oyagüez,10 Javier Rejas11 On behalf of the SEPAR’s Integrated Tobacco Research Program 1Specialised Tobacco Unit, Community of Madrid, 2Tobacco Unit, Department of Pulmonary Medicine, Hospital General Universitario Gregorio Marañón, Madrid, 3Department of Pulmonary Medicine, Hospital Universitario San Juan, Alicante, 4Department of Pulmonary Medicine, Hospital Universitario Fundación Alcorcón, 5Department of Pulmonary Medicine, Hospital Universitario 12 de Octubre, Madrid, 6Department of Pulmonary Medicine, Complejo Hospitalario de Navarra, Pamplona, Navarre, 7Department of Pulmonary Medicine, Hospital de San Pedro Alcántara, Cáceres, 8Drassanes Tobacco Unit, Hospital Universitari Vall-d’Hebron-Drassanes, The Jordi Gol University Institute for Research Primary Healthcare, Barcelona, 9Department of Pulmonary Medicine, Hospital Universitario de Salamanca, Biomedical Research Institute, Salamanca, 10Pharmacoeconomics & Outcomes Research Iberia, 11Department of Pharmacoeconomics and Health Outcomes Research, Pfizer, Sociedad Limitada Unificada, Alcobendas, Madrid, Spain The aim of the study was to assess the budgetary impact of funding smoking-cessation drugs in COPD patients in Spain. A hybrid model (cohort and Markov) was developed for a 5-year time horizon. Only approved cessation drugs (varenicline, bupropion, and nicotine replacement therapy) were considered. Irrespective of the drug, the model allowed for an initial cessation attempt, and up to three additional attempts in case of failure or smoking relapse during a 5-year period. Drug effectiveness was based on controlled clinical trials. National Health System perspective was applied; therefore, only medical resources were included. The pharmaceutical costs for smoking-cessation drugs, extra medical follow-up as a consequence of public reimbursement, and annual savings for health costs avoided due to stopping smoking were considered. The model estimated that 17,756 COPD patients would stop smoking if public funding was available, compared with 1,303 without reimbursement. In the reimbursement scenario, the savings accounted for a total of €48.0 million, compensating for expenditures on drugs and medical visits (€40.4 million). Accumulated total additional savings in 5 years (€4.3 million) compared with the scenario without reimbursement was shown. Sensitivity analyses supported the results robustness. Funding smoking-cessation drugs in COPD patients seems to be an efficient option and a National Health System drug reimbursement scheme would represent a cost-saving policy in Spain. Keywords: pharmacotherapy, COPD, smoking cessation, budgetary impact, health service
Lieven Annemans, , Kristiaan Nackaerts, Pierre Bartsch
Published: 1 January 2015
Preventive Medicine Reports, Volume 2, pp 189-195; https://doi.org/10.1016/j.pmedr.2015.03.004

Abstract:
A recent trial showed the clinical benefit of retreatment with varenicline in subjects failing on the initial treatment, or relapsing after initial success. The objective of this study was to evaluate the cost-effectiveness of retreatment with varenicline compared with other smoking cessation interventions. A published Markov model was adapted to compare one quit attempt of varenicline followed by retreatment to treatment/retreatment with nicotine replacement therapy (NRT), bupropion or placebo, and with only 1 quit attempt of varenicline. Efficacy was obtained from clinical trials. Incidence of smoking-related diseases was based on published data. Cost of therapies and complications was obtained from databases and literature. For 1000 smokers willing to quit, varenicline retreatment saves 275,000€, 118,000€, 316,000€ and 237,000€ compared to NRT, bupropion, placebo, or one single varenicline quit attempt respectively at lifetime and from the healthcare payer perspective. The number of quality adjusted life years gained is 74, 63, 193 and 111 respectively. Sensitivity analyses showed the robustness of these findings. This analysis suggests that in the long term, varenicline retreatment is a dominant intervention, meaning both greater health gains and greater costs saved, over other possible interventions and therefore should be considered as a standard option.
, Ruth Navarro Artieda, Silvia Díaz Cerezo, Belén Martí Sánchez, Veronica Sanz De Burgoa
Published: 30 September 2011
Atención Primaria, Volume 43, pp 482-489; https://doi.org/10.1016/j.aprim.2010.09.010

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José Manuel Rodríguez Barrios, , Carlos Crespo Palomo, Paloma González García, Enrique Antón De Las Heras, Max Brosa Riestra
The European Journal of Health Economics, Volume 13, pp 723-740; https://doi.org/10.1007/s10198-011-0326-y

Abstract:
The objective of this study was to evaluate the methodological characteristics of cost-effectiveness evaluations carried out in Spain, since 1990, which include LYG as an outcome to measure the incremental cost-effectiveness ratio. METHODS: A systematic review of published studies was conducted describing their characteristics and methodological quality. We analyse the cost per LYG results in relation with a commonly accepted Spanish cost-effectiveness threshold and the possible relation with the cost per quality adjusted life year (QALY) gained when they both were calculated for the same economic evaluation. RESULTS: A total of 62 economic evaluations fulfilled the selection criteria, 24 of them including the cost per QALY gained result as well. The methodological quality of the studies was good (55%) or very good (26%). A total of 124 cost per LYG results were obtained with a mean ratio of 49,529 and a median of 11,490 (standard deviation of 183,080). Since 2003, a commonly accepted Spanish threshold has been referenced by 66% of studies. A significant correlation was found between the cost per LYG and cost per QALY gained results (0.89 Spearman-Rho, 0.91 Pearson). CONCLUSIONS: There is an increasing interest for economic health care evaluations in Spain, and the quality of the studies is also improving. Although a commonly accepted threshold exists, further information is needed for decision-making as well as to identify the relationship between the costs per LYG and per QALY gained
Gillian M. Keating,
Published: 1 March 2010
PharmacoEconomics, Volume 28, pp 231-254; https://doi.org/10.2165/11204380-000000000-00000

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