Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD

Abstract

Aims: To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). Design: We used the EQUIPTMOD, a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive phone calls; nicotine replacement therapy (mono and combo) (Rx NRT); varenicline (standard duration); or bupropion. A rate of 3% was used to discount lifetime costs and benefits. Setting: Spain. Participants: Adult smoking population (16+ years). Measurements: Healthcare costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. Findings: The cost of implementing the current provision of smoking cessation services is about €61million in the current year. This translates to 18 quitters per 1000 smokers and a lifetime benefit-cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generated more QALYs) from the lifetime perspective, compared with the current provision. The lifetime benefit-cost ratios were: 1.87 (proactive phone calls); 1.17 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. Conclusions: According to the EQUIPTMOD modelling tool it would be cost-effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro-active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run.