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Cost effectiveness of inpatient initiated varenicline tartrate (VT) plus counselling compared to counselling alone: 2 year follow-up of the Smoking Termination Opportunity for inPatients (STOP) study

Brian Smith, Kristin Carson, Kim Dalziel, Malcolm Brinn, Foruhar Moayeri, Philip Clarke, Matthew Peters, Adrian Esterman
European Respiratory Journal 2016 48: PA4600; DOI: 10.1183/13993003.congress-2016.PA4600
Brian Smith
1Clinical Practice Unit, The Basil Hetzel Institute for Translational Health Research, Adelaide, South AustraliaAustralia
2Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, South AustraliaAustralia
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Kristin Carson
1Clinical Practice Unit, The Basil Hetzel Institute for Translational Health Research, Adelaide, South AustraliaAustralia
2Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, South AustraliaAustralia
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Kim Dalziel
3Centre for Health Policy, University of Melbourne, Melbourne, VictoriaAustralia
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Malcolm Brinn
1Clinical Practice Unit, The Basil Hetzel Institute for Translational Health Research, Adelaide, South AustraliaAustralia
2Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, South AustraliaAustralia
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Foruhar Moayeri
3Centre for Health Policy, University of Melbourne, Melbourne, VictoriaAustralia
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Philip Clarke
3Centre for Health Policy, University of Melbourne, Melbourne, VictoriaAustralia
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Matthew Peters
4Thoracic Medicine, Concord Hospital, Sydney, New South WalesAustralia
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Adrian Esterman
5School of Nursing and Midwifery, University of South Australia, Adelaide, South AustraliaAustralia
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Abstract

Background: VT is currently the most effective smoking cessation pharmacotherapy available, yet its cost-effectiveness is unknown.

Aims: To conduct a cost-effectiveness analysis for the use of VT in the inpatient setting.

Methods: Adult smokers (n=392, 20-75 years) admitted to three metropolitan tertiary hospitals, were randomised to receive either 12-weeks of VT (titrated from 0.5mg daily to 1mg twice-daily) plus Quitline- a phone counselling service (C)(n=196) or C alone (n=196) with completion of the 12 week intervention post discharge. Two year follow-up information was combined with Markov model forecasts to quantify long-term impacts of trial outcome (i.e. observed quit rates) on costs and quality adjusted life year (QALY) gained.

Results: At 2 years, there was a cost of $3,278 per additional person classified as an ex-smoker for the VT+C arm compared to the C arm. Incremental cost-effectiveness of hospital costs over a lifetime for VT+C compared to C was $26,688 per QALY. For the outcome of continuous abstinence at 12-months, the proportion of successful subjects in the VT+C arm was significantly greater with 31.1% (n=61) compared to 21.4% (n=42) in the QCA arm (RR 1.45, 95%CI 1.03 to 2.04, p=0.03). Statistical significance was maintained at 24 month follow-up (28.6 for VT+C group compared to 18.4% for QCA group; p=0.01).

Conclusion: The trial effects modelled over a lifetime indicated that VT+C compared to C costs an estimated $28,688/QALY gained, which is cost-effective compared to many conventionally accepted therapies.

  • Smoking
  • Pharmacology
  • Health policy
  • Copyright ©the authors 2016
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Cost effectiveness of inpatient initiated varenicline tartrate (VT) plus counselling compared to counselling alone: 2 year follow-up of the Smoking Termination Opportunity for inPatients (STOP) study
Brian Smith, Kristin Carson, Kim Dalziel, Malcolm Brinn, Foruhar Moayeri, Philip Clarke, Matthew Peters, Adrian Esterman
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4600; DOI: 10.1183/13993003.congress-2016.PA4600

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Cost effectiveness of inpatient initiated varenicline tartrate (VT) plus counselling compared to counselling alone: 2 year follow-up of the Smoking Termination Opportunity for inPatients (STOP) study
Brian Smith, Kristin Carson, Kim Dalziel, Malcolm Brinn, Foruhar Moayeri, Philip Clarke, Matthew Peters, Adrian Esterman
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4600; DOI: 10.1183/13993003.congress-2016.PA4600
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