Purpose: To evaluate the cost-effectiveness of drugs for smoking cessation in a Norwegian setting.
Method: We preformed a model based economic evaluation of nicotine replacement therapy (NRT), bupropion and varenicline for smoking cessation. The drugs were compared to placebo and to each other. The cost-effectiveness was evaluated through a mortality based Markov model with the health states “smoker”, “quit smoking more than five years ago”, “quit smoking less than five years ago”, ”resumed smoking less than five years ago” and “dead”. We conducted a systematic review of the literature. Uncertainty connected to the efficacy estimates related to the quality of the evidence was incorporated through probability distributions related to the GRADEing of the documentation. Mortality risks connected to smoking in the different health states were taken from data from the Norwegian institute of public health. Health state costs were taken from published studies.
Result: All treatments were less costly and more effective than no treatment. Compared to placebo, nicotine replacement therapy, bupropion and varenicline yielded respectively 0.019, 0.073 and 0.112 additional life years and additional savings of respectively US $ 79, 296 and 456 per person treated. Both NRT and bupropion were dominated by varenicline in the base case results. In the probabilistic sensitivity analysis, varenicline has a probability of 99% of being cost effective compared to placebo. The analysis of expected value of perfect information on parameters indicate that more research is unlikely to reduce decision uncertainty given a willingness to pay per life year gained of US $ 80 000.
Conclusion: Nicotine replacement therapy (NRT), bupropion and varenicline can all be considered cost-effective compared to placebo. When the drugs are evaluated relative to each other, varenicline is very likely to be the most cost-effective alternative.
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