Smoking-cessation therapy using varenicline: the cost-utility of an additional 12-week course of varenicline for the maintenance of smoking abstinence

To evaluate the cost-effectiveness of an additional 12-week treatment with varenicline for abstainers who had successfully completed an initial 12-week treatment. The Benefits of Smoking Cessation on Outcomes simulation model was used to simulate both direct and indirect effects of smoking cessation. All calculations were performed in 2003 Swedish prices. Sweden in 2003. The modelled cohort consisted of 25% of adult smokers motivated to quit smoking (168 844 males and 208 737 females). The age and sex distributions of the cohort reflect that of the Swedish population in 2003. Smokers who had achieved abstinence for at least 7 days following 12-week open-label treatment with varenicline were randomized to receive an additional 12-week treatment with either varenicline or placebo. The incremental costs per quality-adjusted life-year (QALY) gained, for abstainers who received an additional 12-week varenicline treatment compared with only 12 weeks, were 7066 for men and 7108 for women, over a 50-year time horizon. (1 approximate to SEK 9.12). These estimates excluded indirect effects on production and consumption of increased survival. The corresponding incremental costs per QALY including indirect effects were 24 149 and 24 436, respectively. Sensitivity analysis indicated that the estimated cost-utility ratios are robust, but relatively sensitive to treatment efficiency and intervention costs. An additional 12-week course of varenicline treatment, provided to abstainers after an initial 12-week treatment, produces relatively low incremental cost-utility ratios in the spectrum of life-saving medical treatments.