Table 4.

Summary of economic evaluations of nicotine-based pharmacotherapies for smoking cessation^a

Characteristics	Stapleton et al. [1999] (72)	Salize et al. [2009] (67)	Hollis et al. [2007] (45)	Fellows et al. [2007] (31)	An et al. [2006] (2)
Method
Analysis type	CEA	CEA	CEA	CEA	CEA
Model type	RCT and survey	Cluster-randomized trial	Randomized trial	Pre- and postinitiative	Pre- and postinitiative
Framing
Setting and population	Patients who smoke ≥15 cigarettes per day in 15 English counties	Patients who smoke ≥10 cigarettes per day in Germany	Oregon tobacco quitline callers who smoke ≥5 cigarettes per day	Smokers who registered for Oregon quitline service	Callers to the Minnesota QUITPLAN helpline
Intervention (comparator)	GP brief counseling with 16-h nicotine patch treatment and booklet GP brief counseling with placebo and booklet	GP training plus remuneration for each abstinent patient GP training plus cost-free NRT and/or bupropion hydrochloride Combination of above	Brief, moderate, and intensive telephone counseling with or without offers of free nicotine patches	Preinitiative program Oregon tobacco quitline’s “free patch initiative”	Quitline callers before initiative Quitline callers enrolled in multisession counseling received NRT (patch or gum) by mail
Perspective	National Health Service	Health Insurance	State program	Program	Funding agency
Time horizon	12 weeks	1 year	1 year	1 year	6 months
Effects
Main outcome and benefits measure	Life years saved	Abstinence rate	Abstinence rates	Quit rate Life years saved	Quit rate
Cost
Cost analysis (cost components)	Cost of treatment (counseling time, nicotine patches, patient booklets, biochemical validation of abstinence)	Intervention costs	Intervention costs	Pre- and postinitiative costs (media and intervention costs)	Program costs (counseling costs, cost of providing free NRT)
Base year (costs)	1998	2003	2004	2004	Not available
Source (costs)	National survey data, resource use survey	Unit costs per each element of treatment in trial	Program records of resources consumed	Quitline utilization and cost data from state, intervention providers, and patients	Estimated program costs
Results
Summary results	Incremental cost per life year saved if practitioners could prescribe nicotine patch is $656 in patients aged <35 years, $568 in patients aged 35–44 years, $712 in patients aged 45–54 years, and $1,294 in patients aged 55–65 yrs	Compared with usual care, GP training plus drugs and GP training plus drugs and remuneration were cost-effective The cost per additional quitter was $107 per patient for GP training plus drugs and $97 per patient for GP training plus drugs and remuneration	Compared with brief counseling with no NRT, the added costs for each additional quit was $2,467 for brief NRT, $1,912 for moderate no NRT, $2,109 for moderate NRT, $2,640 for intensive no NRT, and $2,112 for intensive NRT	Compared with preinitiative program, free patch initiative increased quitting fourfold and reduced total costs per quit by $2,688. Free patch initiative cost $86 ($22–$353) more per life year saved and $174 more per additional quit	Average number of exsmokers per month increased from 16 to 124; cost per quit increased from $1,362 to $1,934

Characteristics	Fiscella et al. [1996] (32)	Cromwell et al. [1997] (23)	Wasley et al. [1997] (80)	Cornuz et al. [2006] (21)
Method
Analysis type	CEA, CUA	CEA of clinical practice guidelines, CUA	CEA	CEA
Model type	Decision-analytic model	Decision probabilities	Meta-analysis	Markov-chain cohort simulation
Framing
Setting and population	Male and female smokers aged 25–69 years receiving primary care	Simulated model of U.S. smokers aged 18 and older who are willing to make a quit attempt within 1 year	Hypothetical samples of 400 established smokers who smoke ≥20 cigarettes a day	Simulated cohorts of smokers in 6 western countries (Canada, France, Spain, Switzerland, United States, and United Kingdom)
Intervention (comparator)	Physician-based smoking cessation counseling with nicotine patch Physician-based smoking cessation counseling alone	Model of 5 counseling interventions for primary care physicians (minimal, brief, full) and specialists (individual intensive, group intensive) with and without transdermal nicotine and nicotine gum	Nicotine patch with brief counseling Brief physician counseling alone	Brief cessation counseling by GP Counseling plus NRT
Perspective	Payer	Societal	Payer	Third-party payer
Time horizon	Lifetime	1 year	Lifetime	Lifetime
Effects
Main outcome and benefits measure	QALYs saved	QALYs and life years saved Quit rates	Life years saved Quit rates	Life years saved
Cost
Cost analysis (cost components)	Cost of physician time, retail price of nicotine patch	Guideline costs (screening, advice, motivational sessions, interventions)	Physician time, nicotine patch	Additional physician time required, retail price of medications
Base year (costs)	1995	1995	1995	2002–2003
Source (costs)	Published average wholesale price determined by survey	Published literature, guideline reports, Medicare charges	Average retail cost, physicians’ medical fee schedule	Pharmacy prices and published price data from each country
Results
Summary results	The patch produced 1 additional lifetime quitter at a cost of $7,332 Incremental cost-effectiveness of the patch ranged from $4,390 to $10,943 per QALY in men and $4,955–$6,983 per QALY in women	Guidelines yield cost of $3,779 per quitter, $2,587 per life year saved, and $1,915 per QALY saved. Costs per QALY ranged from $1,108 to $4,542 with more intensive interventions being more cost-effective	Average cost per year of life saved ranged from $965 to $1,585 for men and from $1,634 to $2,360 for women Incremental cost per year of life saved ranged from $1,796 to $2,949 for men and from $3,040 to $4,391 for women	Cost per life year saved range: Gum: $2,230 men, $7,643 women Patch: $1,758 men, $5,131 women Spray: $1,935 men, $7,969 women Inhaler: $3,480 men, $8,700 women Bupropion: $792 men, $2,922 women

Characteristics	Gilbert et al. [2004] (36)	Oster et al. [1986] (59)	Feenstra et al. [2005] (30)	Crealey et al. [1998] (22)	Tran et al. [2002] (76)
Method
Analysis type	CEA	CEA	CEA, CUA	CEA	CEA, CUA
Model type	Markov chain cohort simulation	Meta-analysis	RIVM chronic disease	Case control	Observations
Framing
Setting and population	Two simulated cohorts of smokers in Seychelles	Hypothetical group of smokers seen in routine office visits	Smokers in the Netherlands	Matched cases and controls in PAS model program in Northern Ireland	Patients aged 21–70 who had tried at least once to quit smoking
Intervention (comparator)	Physician counseling alone Counseling plus one of 5 cessation therapies (gum, patch, spray, inhaler, Bupropion)	Physician advice and counseling alone Nicotine gum and physician advice	Minimal counseling by a GP with or without NRT Intensive counseling with NRT or bupropion Telephone counseling	Cases received advice and motivation from pharmacist Matched controls received usual advice from pharmacists	Pharmacist-directed smoking cessation program using 4 methods (cold turkey, patch, gum, bupropion) Self-directed quit attempt
Perspective	Third-party payer	Payer	Societal	Payer	Payer, Societal
Time horizon	Lifetime	Lifetime	1, 10, or 75 years	Lifetime	1 year, lifetime
Effects
Main outcome and benefits measure	Life years saved	Life years saved	Quit rate Life years gained QALYs gained	Life years saved	Quit rate Life year saved QALYs saved
Cost
Cost analysis (cost components)	Additional physician time required Retail prices of treatment (generic medications on global market and U.S. treatment prices)	Physicians time, gum	Intervention costs Direct health-care costs from 11 smoking-related diseases	Direct intervention costs (PAS materials, training for pharmacists, time counseling)	Program costs (materials, pharmacist time) Retail cost of selected cessation methods
Base year (costs)	2002–2003	1984	2000	1997	1997
Source (costs)	Retail prices, wage data	Retail prices, salary rates	Estimated retail costs, standard costing manual, salary data	Estimates of program costs, salary rates	Salary data, retail costs
Results
Summary results	Incremental cost per life year saved using U.S. prices was $3,712 for gum, $1,982 for patch, $4,597 for spray, $4,291 for inhaler, and $1,324 for bupropion	Cost per life year saved ranged from $4,113 to $6,465 in men and $6,880–$9,473 in women	Cost per QALY gained ranged from $1,109 for telephone counseling to $4,939 for intensive counseling with nicotine patches or gum	Cost per life year saved for PAS program was $337–$603 for men and $310–$1,322 for women	Incremental costs using pharmacist-directed program were $236 for cold turkey, $936 for patch, $1,232 for gum, $1,150 for bupropion

^aAbbreviations: CEA, cost-effectiveness analysis; CUA, cost-utility analysis; GP, general practitioner; NRT, nicotine replacement therapy; PAS, pharmacists action on smoking; QALYs, quality-adjusted life years; RCT, randomized-controlled trial; RIVM, chronic disease model developed at the National Institute of Public Health and the Environment in the Netherlands.