Cost-Effectiveness of Real World Administration of Tobacco Pharmacotherapy in the United States Veterans Health Administration.

Barnett PG, Ignacio RV, Kim HM, Geraci MC, Essenmacher CA, Hall SV, Sherman SE, Duffy SA
Addiction in press 03/29/2019


BACKGROUND AND AIMS : Cost-effectiveness studies in randomized clinical trials have shown that tobacco cessation pharmacotherapy is among the most cost-effective of health care interventions. Clinical trial eligibility criteria and treatment protocols may not be followed in actual practice. This study aimed to determine whether tobacco cessation pharmacotherapy is cost-effective in real-world settings.

DESIGN : A retrospective analysis of costs and outcomes SETTING: Hospitals and clinics of the US Veterans Health Administration, USA.

PARTICIPANTS : A total of 589,862 US veterans who screened positive for tobacco use in 2011.

INTERVENTION AND COMPARATOR : Tobacco users who initiated smoking cessation pharmacotherapy in the 6 months after screening were compared with those who did not use pharmacotherapy in this period. Pharmacotherapy included nicotine replacement theapy, bupropion (if prescribed at 300 mg per day or specifically for tobacco cessation), or varenicline.

MEASURES : Effectiveness was determined from responses to a subsequent tobacco screening conducted between 7 and 18 months after the treatment observation period. Cost of medications and prescribing health care encounters was determined for the period between initial and follow-up tobacco use screening. Multivariate fixed -effects regression was used to assess the effect of initial treatment status on cost and outcome while controlling for differences in case-mix with propensity weighting to adjust for confounding by indication.

FINDINGS : 13.0% of participants received tobacco cessation pharmacotherapy within 6 months of initial screening. After an average of an additional 218 days follow-up, those who initially received pharmacotherapy incurred $144 in additional treatment cost and had a 3.1% absolute increase in tobacco quit rates compared with those who were not initially treated. This represents an incremental cost-effectiveness ratio of $4,705 per quit. The upper limit of the 99.9% confidence region was $5,600 per quit. Without propensity adjustment, the cost-effectiveness ratio was $7,144 per quit, with the upper limit of the 99.9% confidence region $9,500/quit.

CONCLUSIONS : Tobacco cessation pharmacotherapy provided by the US Veterans Health Administration in 2011/12 was cost-effective in this real-world setting, with an incremental cost-effectiveness ratio of $4,705 per quit.

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