PURPOSE: To develop a computer aided model to evaluate the cost-effectiveness of various smoking cessation treatments (nicotine replacement therapy-patch, gum, lozenge, inhaler, or nasal spray; bupropion; varenicline; or “cold turkey”). The model will estimate health and economic outcomes associated with smoking cessation interventions. It will allow clinicians to account for health status changes over time and simulates patient status and possible health outcomes that are more representative of patients encountered in clinical practice.
METHODS: We developed a discrete event simulation model which allows for individual level variation in smoking intensity and relapse to assess smoking cessation effectiveness. Data from the literature is used to simulate patients’ responses to various interventions. Outcomes of interest include estimates of smoking cessation success, health care related costs due to long term effects of smoking (defined as lung cancer, COPD, stroke, coronary heart disease), and cost per quality adjusted life year saved. The chance of developing disease for an individual patient is assessed at intervals of 1, 5, 10, and 30 years.
RESULTS: Based on the simulation model, patients that received nicotine replacement therapy had a 87% recidivism rate at 1 year and 93% at 30 years. In those that received bupropion and varenicline 77% and 78% were still smoking at 1 year and 88% and 89% remained smokers at 30 years, respectively. Those that quit unassisted had a recidivism rate of 95% at 1 year and 98% at 30 years. The average cost per quality adjusted life year saved was greater at 30 years for all three treatment groups (NRT, bupropion, and varenicline) compared to those that quit unassisted.
CONCLUSIONS: Smoking cessation treatments increase the probability of patients quitting smoking. Our model suggest that smoking cessation interventions are cost effective, and quality of life is improved.
CLINICAL IMPLICATIONS: It is critical for clinicians to recommend smoking cessation therapy to patients. Cost of these interventions is outweighed by the long term health benefits to patients and reduced economic disease burden to society.
DISCLOSURE: The following authors have nothing to disclose: Luca Paoletti, Odette Reifsnider, Stephanie Wheeler, Matthew Carpenter, Paul Nietert, Maria Mayorga, Gerard Silvestri
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