PT  - JOURNAL ARTICLE
AU  - Brian Smith
AU  - Kristin Carson
AU  - Kim Dalziel
AU  - Malcolm Brinn
AU  - Foruhar Moayeri
AU  - Philip Clarke
AU  - Matthew Peters
AU  - Adrian Esterman
TI  - 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
AID  - 10.1183/13993003.congress-2016.PA4600
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - PA4600
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/PA4600.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/PA4600.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - 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.