Transcript Cost-effectiveness of five different smoking cessation

Cost-effectiveness of five
different smoking cessation
medication treatments
Melissa Natzke
Doctor of Pharmacy Candidate
Master of Public Health Candidate
Acknowledgements






Megan Piper, PhD
Doug Jorenby, PhD
Michael Fiore, MD, MPH
Dave Kreling, RPh, MS, PhD
John Mullahy, PhD
Paul Fishman, PhD
Introduction



Cigarette smoking is the leading preventable
cause of morbidity and mortality in the world
From 2001-2004, medical costs plus lost
productivity attributable to smoking in the US
totaled ~$193 billion dollars per year
In comparison, in 2002 less than $900 million
dollars were spent on state-level tobacco
control programs
Introduction



Tobacco cessation treatment is an extremely costeffective use of health care dollars
There are seven effective, FDA-approved tobacco
cessation pharmacotherapies recommended by the
2008 Public Health Service Guideline
Although combination pharmacotherapy may be
particularly effective for tobacco cessation, cost
effectiveness data is limited and is needed to help in
selecting treatments
Objective

Examine the relative cost-effectiveness of
three single pharmacotherapies and two
combination pharmacotherapies using
placebo-controlled, head-to-head efficacy data
from a single study
Demographics (n=1504)

58.2% female


83.9% self-identified
Caucasian
13.6% self-identified African
American

Average age: 44.7 (SD 11.1)
Cigarettes/day: 21.4 (SD 8.9)





23.5% <$25,000 annual
household income
42.9% >$50,000 annual
household income
23.6% had a high school
education only
21.9% reported a 4-year
college degree
Interventions


All conditions received six, brief, individual
counseling sessions
Six experimental conditions:






Placebo (n = 189)
Nicotine lozenge (n = 260)
Nicotine patch (n = 262)
Bupropion SR (n = 264)
Nicotine patch plus nicotine lozenge (n = 267)
Bupropion SR plus nicotine lozenge (n = 262)
Methods

Two distinct perspectives:





Cash-paying patient
Third-party payer
Cash prices an average from Walgreens and CVS
pharmacies
Third-party reimbursement 60% AWP from 2008
Red Book
Efficacy determined by subtracting placebo efficacy
from total efficacy at 8 weeks (end of treatment) and
6 months
Methods

Calculated drug quantities at 8 weeks and 6
months



Bupropion and patch – total expected usage
Lozenge – median usage calculated from
directions; multiplied by 2/3 for actual prn usage
Cost effectiveness = (cost per 100 patients)
(# quit per 100 patients)
Incremental Efficacy
Incremental Efficacy (%)
23.4
25
20.2
20
17.9
14.5
15
10
11.3
10.3 9.6
10.2
Bupropion
Lozenge
12.2
8 week
11
6 month
5
0
Patch
Bupropion +
Lozenge
Patch +
Lozenge
$2,000.00
$1,500.00
$1
,04
8.0
0
$1
,24
5.5
7
$2,500.00
$1
,65
1.6
7
$1
,79
4.6
0
$3,000.00
$1
,79
9.9
0
$1
,93
1.1
5
$3,500.00
$1
,36
9.3
$16
,98
1.8
4
$4,000.00
$1
,75
1.7
8
$3
,52
8.9
1
Cost per Quit – Cash Paying
$1,000.00
$500.00
$0.00
Bupropion
Lozenge
Patch
Bupropion +
Lozenge
Patch + Lozenge
8 week
6 month
$1,200.00
$800.00
$600.00
$5
23
.05
$5
61
.19
$1,000.00
$1
,19
7.8
5
$1,400.00
$5
95
.53
$7
07
.80
$1
,06
0.7
1
$1
,13
3.3
1
$1,600.00
$8
31
.38
$1,800.00
$8
02
.31
$1
,65
3.9
8
Cost per Quit – Third-Party Payer
6 month
$400.00
$200.00
$0.00
Bupropion
Lozenge
Patch
8 week
Bupropion +
Lozenge
Patch + Lozenge
Discussion




The combination of the patch plus lozenge produced
the highest incremental 6-month abstinence rates
(17.9%)
Monotherapy with either bupropion SR (third-party)
or the nicotine patch (cash-paying) is the most costeffective approach to achieve tobacco cessation
Cost-effectiveness should not be the sole basis for
choosing a tobacco cessation treatment
All therapies are cost-effective compared with
continuing to use tobacco
Conclusion


These results add further support to the notion
that tobacco cessation treatment is highly cost
effective
No matter what treatment is used, the most
important thing smokers can do for their
health is quit smoking