Cost-Utility Analysis of Varenicline versus Existing Smoking Cessation Strategies using the BENESCO Simulation Model: Application to a Population of US Adult Smokers

Background: Of 1_346_700 total deaths each year in the US, an estimated 440_100 are smoking related, making it the leading preventable cause of premature death in the US. Despite the health and economic benefits of smoking cessation being well documented, reimbursement coverage for smoking cessation therapies is generally limited in the US and elsewhere. Objectives: To evaluate the cost effectiveness of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, recently approved to aid smoking cessation. Methods: A Markov model, the Benefits of Smoking Cessation on Outcomes (BENESCO) model, was developed to simulate the lifetime direct costs and consequences of a hypothetical cohort of US adult smokers who make a one-time attempt to quit smoking. The smoking cessation strategies compared were varenicline, bupropion, nicotine replacement therapy and unaided quitting. The model used the hazard ratios from the Cancer Prevention Study (CPS)-II study for the mortality of smoking-related diseases as a proxy to calculate the relative risks of the incidence and prevalence of these diseases, following previously developed methodology. The costs (year 2005 values) and utilities for the included smoking-related diseases (lung cancer, chronic obstructive lung disease [COPD], coronary heart disease [CHD], stroke and asthma exacerbations), and the efficacies of the smoking cessation strategies, were sourced from the published literature. Costs and benefits were discounted at 3% pa. Probabilistic and univariate sensitivity analyses were conducted. Results: Varenicline was found to dominate all other smoking cessation strategies that were investigated for both the 20-year and lifetime timeframe. Furthermore, if 25% of the current population of US smokers made a one-time attempt to quit using varenicline compared with unaided cessation, almost 144_000 smoking-related deaths and over 261_000 cases of asthma exacerbations, COPD, CHD, stroke and lung cancer could be avoided compared with an unaided smoking cessation strategy. Conclusions: Varenicline, a recently approved therapy for smoking cessation, is likely to be a cost-effective alternative compared with currently available options.