All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context
AIMS To identify different types of models used in economic evaluations of smoking cessation , analyse the quality of the included models examining their attributes and ascertain their transferability to a new context .
A Discrete-Event Simulation of Smoking-Cessation Strategies Based on Varenicline Pivotal Trial Data
Background Smoking is the leading cause of preventable death in the US . While one in five individuals smoke , and 70 % of these indicate a desire to quit , < 5 % of unaided quit attempts succeed . Cessation aids can double or triple the odds of successfully quitting . Models of smoking-cessation behaviour can eluci date the implication s of individual abstinence patterns to allow better tailoring of quit attempts to an individual ’s characteristics . Objective The objectives of this study were to develop and vali date a discrete-event simulation ( DES ) to evaluate the benefits of smoking abstinence using data from the pooled pivotal clinical trials of varenicline versus bupropion or placebo for smoking cessation and to provide a foundation for the development of a lifetime smoking-cessation model . Methods The DES model simulated the outcome of a single smoking-cessation attempt over 1 year , in accordance with the clinical trial timeframes . Pharmaceutical costs were assessed from the perspective of a healthcare payer . The model r and omly sample d patient profiles from the pooled varenicline clinical trials . All patients were physically and mentally healthy adult smokers who were motivated to quit abruptly . The model allowed for comparisons of up to five distinct treatment approaches for smoking cessation . In the current analyses , three interventions corresponding to the clinical trials were evaluated , which included brief counselling plus varenicline 1.0 mg twice daily ( bid ) or bupropion SR 150 mg bid versus placebo ( i.e. brief counselling only ) . The treatment periods in the clinical trials were 12 weeks ( target quit date : day 8) , with a 40-week non-treatment follow-up , and counselling continuing over the entire 52-week period in all treatment groups . The main outcome modelled was the continuous abstinence rate ( CAR ; defined as complete abstinence from smoking and confirmed by exhaled carbon monoxide ≤10 ppm ) at end of treatment ( weeks 9–12 ) and long-term follow-up ( weeks 9–52 ) , and total time abstinent from smoking over the course of 52 weeks . The model also evaluated costs and cost-effectiveness outcomes . Results For the varenicline , bupropion and placebo cohorts , respectively , the model predicted CARs for weeks 9–12 of 44.3 % , 30.4 % and 18.6 % compared with observed rates of 44.0 % , 29.7 % and 17.7 % ; over weeks 9–52 , predicted CARs in the model compared with observed rates in the pooled clinical studies were 22.9 % , 16.4 % and 9.4 % versus 22.4 % , 15.4 % and 9.3 % , respectively . Total mean abstinence times accrued in the model varenicline , bupropion and placebo groups , respectively , were 3.6 , 2.6 and 1.5 months and total pharmaceutical treatment costs were $ US261 , $ US442 and $ US0 ( year 2008 values ) over the 1-year model period . Using cost per abstinent-month achieved as a measure of cost effectiveness , varenicline dominated bupropion and yielded an incremental cost-effectiveness ratio of $ US124 compared with placebo . Conclusion The model accurately replicated abstinence patterns observed in the clinical trial data using individualized predictions and indicated that varenicline was more effective and may be less costly than bupropion . This simulation incorporated individual predictions of abstinence and relapse , and provides a framework for lifetime modelling that considers multiple quit attempts over time in diverse patient population s using a variety of quit attempt strategies
All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context
AIMS To identify different types of models used in economic evaluations of smoking cessation , analyse the quality of the included models examining their attributes and ascertain their transferability to a new context .