Purpose: This study aims to estimate the health and economic impact of different strategies (nicotine replacement therapy, bupropion, varenicline, and non-pharmacologic-assisted cessation) for smoking cessation in achieving long-term abstinence from cigarette smoking.
Method: A discrete-event simulation model was developed to allow for individual-level variation in treatment adherence, relapse, and risk of co-morbidity/mortality in assessing the effectiveness of smoking cessation interventions. We utilized data from multiple sources (US Census, Centers for Disease Control and Prevention, and literature) to simulate individuals’ actions and associated responses to different interventions along with smoking-related co-morbidities. Outcomes of interest included estimates of sustained abstinence from smoking, quality adjusted life years, cost of treatment, and additional health-related costs due to long-term effects of smoking (lung cancer, and chronic obstructive pulmonary disease, stroke, coronary heart disease). Cost-effectiveness analysis was performed after a horizon of 1 year, 10 years, 30 years, and lifetime.
Result: Among 10,000 smokers attempting to quit smoking, 1 year recidivism rates among those alive at follow-up were the following: nicotine replacement treatment, 86.94%; bupropion, 77.43%; varenicline, 78.41%, and non-pharmacologic-assisted, 95.04%. Nicotine replacement treatment, bupropion, varenicline, and non-pharmacologic-assisted had a recidivism rate of 93.68%, 88.98%, 89.72%, 97.42% among those alive at 30 years, respectively. Comparing nicotine replacement treatment, bupropion and varenicline to non-pharmacologic-assisted cessation produced cost per quality adjusted life years saved of -1.69, -1.54, and -2.61 at lifetime, respectively.
Conclusion: Nicotine replacement treatment, bupropion, and varenicline are cost-effective and quality of life is improved in comparison with non-pharmacologic-assisted cessation. Varenicline is the dominant treatment option when comparing pharmacologic options for smoking cessation.
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