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An economic evaluation based on a randomized placebo-controlled trial of varenicline in smokers with cardiovascular disease: Results for Belgium, Spain, Portugal, and Italy

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Wilson, Koo [Pfizer Ltd, Surrey, UK] Hettle, Robert [Health Economic Modelling Unit, HERON Evidence Development Ltd., Luton, UK] Marbaix, Sophie [Pfizer sa-nv, Brussels, Belgium] Cerezo, Silvia Diaz [Pfizer, S.A., Avda. de Europa, Madrid] Ines, Monica [Laboratórios Pfizer, Lda, Porto Salvo, Portugal] Prignot, Jacques [UCL] De Sa, Esteban Lopez [Cardiology Department, La Paz University Hospital, Madrid]

Background: An estimated 17.2% of patients continue to smoke following diagnosis of cardiovascular disease (CVD). To reduce the risk of further morbidity or mortality in cardiovascular patients, smoking cessation has been shown to reduce the risk of mortality by 36% and myocardial infarction by 32%. The objective of this study was to evaluate the long-term health and economic consequences of smoking cessation in patients with CVD. Design and methods: Results of a randomized clinical trial comparing varenicline plus counselling vs. placebo plus counselling were extrapolated using a Markov model to simulate the lifetime costs and health consequences of smoking cessation in patients with stable CVD. For the base case, we considered a payer's perspective including direct costs attributed to the healthcare provider, measuring cumulative life years (LY) and quality adjusted life (QALY) years as outcome measures. Secondary analyses were conducted from a societal perspective, evaluating lost productivity due to premature mortality. Sensitivity and subgroup analyses were also undertaken. Results were analysed for Belgium, Spain, Portugal, and Italy. Results: Varenicline plus counselling was associated with a gain in LY and QALY across all countries; relative to placebo plus counselling. From a payer's perspective, incremental cost effectiveness ratios were €6120 (Belgium), €5151 (Spain), €5357 (Portugal), and €5433 (Italy) per QALY gained. From a societal perspective, varenicline in addition to counselling was less costly than placebo and counselling in all cases. Sensitivity analyses showed little sensitivity in outcomes to model assumptions or uncertainty in model parameters. Conclusions: Varenicline in addition to counselling is cost-effective compared to placebo and counselling in smokers with CVD. © 2011 The European Society of Cardiology.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès interdit
Publication date 2012
Language Anglais
Journal information "European Journal of Preventive Cardiology" - Vol. 19, no. 5, p. 1173-1183 (2012)
Peer reviewed yes
Publisher Sage Publications Ltd.
e-issn 2047-4881
issn 2047-4873
Publication status Publié
Affiliation UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
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Bibliographic reference Wilson, Koo ; Hettle, Robert ; Marbaix, Sophie ; Cerezo, Silvia Diaz ; Ines, Monica ; et. al. An economic evaluation based on a randomized placebo-controlled trial of varenicline in smokers with cardiovascular disease: Results for Belgium, Spain, Portugal, and Italy. In: European Journal of Preventive Cardiology, Vol. 19, no. 5, p. 1173-1183 (2012)
Permanent URL http://hdl.handle.net/2078.1/161387