1
|
Chaisai C, Patikorn C, Thavorn K, Lee SWH, Chaiyakunapruk N, Veettil SK. Incremental net monetary benefit of using varenicline for smoking cessation: A systematic review and meta-analysis of economic evaluation studies. Addiction 2024; 119:1188-1202. [PMID: 38520121 DOI: 10.1111/add.16464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 01/25/2024] [Indexed: 03/25/2024]
Abstract
AIMS To conduct a systematic review and meta-analysis and pool the incremental net benefits (INBs) of varenicline compared with behaviour support with bupropion or nicotine replacement therapy (NRT), behaviour support alone and unaided cessation in adult smokers making a first-time attempt to quit. METHODS A search for economic evaluation studies was conducted from inception to 30 September 2022, on PubMed, Embase, Cost-Effectiveness Analysis (CEA) Registry by Tufts Medical Centre, EconLit and the NHS Economic Evaluation Database (NHS EED). Eligible studies were included if they were (1) conducted among adults ages 18 years old and older who were smokers attempting to quit for the first time; (2) compared varenicline to behaviour support with bupropion or NRT, behaviour support alone and unaided cessation; and (3) performed a CEA or cost-utility analysis. The INBs were calculated and pooled across studies stratified by country income level and study perspective using the random-effects model. Statistical heterogeneity between studies was assessed using the I2 statistic and Cochrane Q statistic. RESULTS Of the 1433 identified studies, 18 studies were included in our review. Our findings from healthcare system/payer perspective suggested that the use of varenicline is statistically significantly cost-effective compared with bupropion (pooled INB, $830.75 [95% confidence interval, $208.23, $1453.28]), NRTs ($636.16 [$192.48, $1079.84]) and unaided cessation ($4212.35 [$1755.79, $6668.92]) in high-income countries. Similarly, varenicline is also found to be cost-effective compared to bupropion ($2706.27 [$1284.44, $4128.11]), NRTs ($3310.01 [$1781.53, $4838.50]) and behavioural support alone ($5438.22 [$4105.99, $6770.46]) in low- and middle-income countries. CONCLUSION Varenicline is cost-effective as a smoking cessation aid when compared with behavioural support with bupropion or nicotine replacement therapies and behavioural support alone in both high-income countries and low- and middle-income countries, from the healthcare system/payer perspective in adult smokers who attempt to quit for the first time.
Collapse
Affiliation(s)
- Chayutthaphong Chaisai
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chanthawat Patikorn
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- School of Medicine, Taylor's University, Selangor, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- IDEAS Centre, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Sajesh K Veettil
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- School of Medicine, Taylor's University, Selangor, Malaysia
- School of Pharmacy, Department of Pharmacy Practice, International Medical University, Kuala Lumpur, Malaysia
| |
Collapse
|
2
|
Phillips L, Campbell KA, Coleman T, Ussher M, Cooper S, Lewis S, Orton S. Barriers and Facilitators to Staying Smoke-Free after Having a Baby, a Qualitative Study: Women's Views on Support Needed to Prevent Returning to Smoking Postpartum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111358. [PMID: 34769875 PMCID: PMC8583693 DOI: 10.3390/ijerph182111358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Abstract
Background: Postpartum return to smoking (PPRS) is a common and important public health problem. Interventions to prevent PPRS have not been shown to be effective. We aimed to qualitatively explore the barriers and facilitators to staying smoke-free after having a baby, and women’s views on the support needed to avoid PPRS to inform future intervention development. Methods: We conducted semi-structured telephone interviews (n = 26) with pregnant women who quit smoking (n = 9), and postpartum women who were abstinent at delivery and returned to smoking (n = 7) or stayed smoke-free (n = 10). Inductive thematic analysis was used. Results: Five overarching themes were identified: (i) smoking intentions; (ii) facilitators to staying smoke-free; (iii) barriers to staying smoke-free; (iv) support to avoid relapse; and (v) e-cigarettes, nicotine replacement therapy, and varenicline. Facilitators to staying smoke-free were the health benefits to their baby, whilst barriers included stress, cravings, and being in environments where they would previously have smoked. Women wanted continuous offers of support to stay smoke-free throughout the extended postpartum period, with a particular interest in support for partners to quit smoking and self-help support. Women expressed safety concerns for e-cigarettes, nicotine replacement therapy, and varenicline. Conclusions: Offers of support to stay smoke-free should continue throughout the postpartum and engage with partners or other household members who smoke. Reassuring women about the relative safety of nicotine replacement therapy and e-cigarettes by a health professional, particularly for those who are breastfeeding, could be beneficial.
Collapse
Affiliation(s)
- Lucy Phillips
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Katarzyna Anna Campbell
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Michael Ussher
- Population Health Research Institute, St. George’s University of London, London SW17 0RE, UK;
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
| | - Sue Cooper
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Sophie Orton
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
- Correspondence:
| |
Collapse
|
3
|
Akers L, Merianos AL, Mahabee-Gittens EM. Costs to provide a tobacco cessation intervention with parents of pediatric emergency department patients. Tob Prev Cessat 2020; 6:63. [PMID: 33241163 PMCID: PMC7682487 DOI: 10.18332/tpc/128320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pediatric emergency department (PED) visits are opportune times in which to provide smoking cessation interventions for parents who smoke. This study reports on the costs of providing parental smokers who bring their children to the emergency setting, with a screening, brief intervention, and assisted referral to treatment (SBIRT) intervention, which includes counseling about tobacco cessation and nicotine replacement therapy. METHODS Cost data were collected during a randomized controlled trial with 750 parental smokers whose child was presented to a PED or pediatric Urgent Care unit with a potential tobacco smoke exposure-related illness. Interventionist training, screening, and SBIRT costs are reported from the organizational perspective (i.e. that of the providing hospital). A spreadsheet tool was created to allow for organizations to estimate their own costs based on their settings, for each aspect of the intervention. RESULTS The mean costs per parent included interventionist training, screening and enrollment, SBIRT delivery, distribution of take-home materials and nicotine replacement therapy, booster text messages, and follow-up phone contact. The total cost per parent was approximately $97. Varying the underlying cost assumptions led to total costs ranging from $85 to $124 per treated parent. CONCLUSIONS The emergency setting is an important locus of tobacco control that could have a large public health benefit to parents and children. The costs reported in this report and the accompanying spreadsheet tool will permit emergency settings to estimate the costs and assist with planning, staffing and resource allocation necessary to implement an SBIRT smoking cessation intervention in research-based and clinically-based cessation interventions into adult or pediatric emergency visits.
Collapse
Affiliation(s)
- Laura Akers
- Oregon Research Institute, Eugene, United Stated
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, United States
| | - E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, United States
| |
Collapse
|
4
|
Love-Koh J, Pennington B, Owen L, Taylor M, Griffin S. How health inequalities accumulate and combine to affect treatment value: A distributional cost-effectiveness analysis of smoking cessation interventions. Soc Sci Med 2020; 265:113339. [PMID: 33039733 DOI: 10.1016/j.socscimed.2020.113339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2020] [Accepted: 08/28/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Reduction of health inequality is a goal in health policy, but commissioners lack information on how policies change health inequality. This study illustrates how decision models can be readily extended to produce information on health inequality impacts as well as for population health, using the example of smoking cessation therapies. METHODS We retrospectively adapt a model developed for public health guidance to undertake distributional cost effectiveness analysis. We identify and incorporate evidence on how inputs vary by area-level deprivation. Therapies are evaluated in terms of total population health, extent of inequality, and a summary measure of equally distributed equivalent health based on a societal value for inequality aversion. Last, we examine how accounting for social variation in different sets of parameters affects our results. RESULTS All interventions increase population health and increase the slope index ofinequality. At estimated levels of health inequality aversion for England, our resultsindicate that the increases in inequality are compensated by the health gains. DISCUSSION The inequality impacts are driven by higher benefits of quitting and higher intervention uptake amongst advantaged groups, despite the greater proportion of smokers in disadvantaged groups. Failure to account for differential effects between groups leadsto different conclusions about health inequality impact but does not alter conclusionsabout value for money.
Collapse
Affiliation(s)
| | - Becky Pennington
- Health Economics and Decision Science, University of Sheffield, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, UK
| | - Matthew Taylor
- York Health Economics Consortium, University of York, UK
| | | |
Collapse
|
5
|
Leone FT, Zhang Y, Evers-Casey S, Evins AE, Eakin MN, Fathi J, Fennig K, Folan P, Galiatsatos P, Gogineni H, Kantrow S, Kathuria H, Lamphere T, Neptune E, Pacheco MC, Pakhale S, Prezant D, Sachs DPL, Toll B, Upson D, Xiao D, Cruz-Lopes L, Fulone I, Murray RL, O’Brien KK, Pavalagantharajah S, Ross S, Zhang Y, Zhu M. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e5-e31. [PMID: 32663106 PMCID: PMC7365361 DOI: 10.1164/rccm.202005-1982st] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams.Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations.Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes.Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.
Collapse
|
6
|
Lima DR, Carvalho CFC, Guimarães-Pereira BBS, Loreto AR, Frallonardo FP, Ismael F, Andrade AGD, Castaldelli-Maia JM. Abstinence and retention outcomes in a smoking cessation program among individuals with co-morbid substance use and mental disorders. J Psychiatr Res 2020; 125:121-128. [PMID: 32272242 DOI: 10.1016/j.jpsychires.2020.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
Tobacco use is the leading cause of preventable death in the world. Although cigarette smoking prevalence has decreased, there are still disparities in morbidity and mortality experienced by individuals with substance use and/or mental disorders when compared to general population. The aim of this study was to compare treatment outcomes between three subgroups of smokers: individuals with substance use disorder (SUD-only), individuals with mental disorder without substance use disorders (MD-only), and individuals with co-morbid substance use and mental disorder (SUD + MD). Data of 498 smokers enrolled in a 6-week smoking cessation program in Brazil were analyzed. Sociodemographic, medical and tobacco use information were collected at baseline. Treatment included group cognitive behavioral therapy (CBT) and pharmacotherapy. The primary outcome was defined as "self-report 4-week quitter" (SR4WQ), a standardized measure to assess treatment success. Retention to treatment was also investigated. Associations between groups were analyzed using unadjusted and adjusted logistic regression models. The results showed that SUD + MD had worse outcomes when compared to the other two groups. After adjusting for level of smoking dependence and the use of medication, abstinence and retention to treatment of SUD-only became equivalent to SUD + MD. Because tobacco and other substance addictions share similar mechanisms, having history of SUD might impair successful results of conventional smoking programs. There is a need to further investigate specific variables associated with treatment success for a more resistant subgroup of individuals in mental health and perhaps to invest in more intensive actions, such as the use of combined pharmacotherapy and adapted CBT approaches.
Collapse
Affiliation(s)
- Danielle Ruiz Lima
- Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr.Ovídio Pires de Campos, 785, Cerqueira César, 05403-010, São Paulo, SP, Brazil.
| | - Carlos Felipe Cavalcanti Carvalho
- ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - Bruna Beatriz Sales Guimarães-Pereira
- Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - Aline Rodrigues Loreto
- Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - Fernanda Piotto Frallonardo
- ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Universidade Municipal de São Caetano do Sul - Campus Centro, Rua Santo Antonio, 50 - São Caetano do Sul, São Paulo, 09521-160, Brazil
| | - Flávia Ismael
- ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Universidade Municipal de São Caetano do Sul - Campus Centro, Rua Santo Antonio, 50 - São Caetano do Sul, São Paulo, 09521-160, Brazil
| | - Arthur Guerra de Andrade
- Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr.Ovídio Pires de Campos, 785, Cerqueira César, 05403-010, São Paulo, SP, Brazil; ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - João Mauricio Castaldelli-Maia
- Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr.Ovídio Pires de Campos, 785, Cerqueira César, 05403-010, São Paulo, SP, Brazil; ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| |
Collapse
|
7
|
Smoking cessation treatment outcomes among people with and without mental and substance use disorders: An observational real-world study. Eur Psychiatry 2020; 52:22-28. [DOI: 10.1016/j.eurpsy.2018.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/11/2018] [Accepted: 02/28/2018] [Indexed: 11/21/2022] Open
Abstract
AbstractBackground:There is a lack of studies evaluating smoking cessation treatment protocols which include people with and without mental and substance use disorders (MSUD), and which allows for individuals with MSUD undergoing their psychiatric treatment.Methods:We compared treatment success between participants with (n = 277) and without (n = 419) MSUD among patients in a 6-week treatment provided by a Brazilian Psychosocial Care Center (CAPS) from 2007 to 2013. Sociodemographic, medical and tobacco use characteristics were assessed at baseline. Tobacco treatment consisted of 1) group cognitive behavior therapy, which included people with and without MSUD in the same groups, and 2) pharmacotherapy, which could include either nicotine patches, nicotine gum, bupropion or nortriptyline. For participants with MSUD, tobacco treatment was integrated into their ongoing mental health treatment. The main outcome was 30-day point prevalence abstinence, measured at last day of treatment.Results:Abstinence rates did not differ significantly between participants with and without MSUD (31.1% and 34.4%, respectively). Variables that were significantly associated with treatment success included years smoking, the Heaviness of Smoking Index, and use of nicotine patch or bupropion.Conclusions:The inclusion of individuals with and without MSUD in the same protocol, allowing for individuals with MSUD undergoing their psychiatric treatment, generates at least comparable success rates between the groups. Predictors of treatment success were similar to those found in the general population. Facilities that treat patients with MSUD should treat tobacco use in order to reduce the disparities in morbidity and mortality experienced by this population.
Collapse
|
8
|
Sohanpal R, Jumbe S, James WY, Steed L, Yau T, Rivas C, Madurasinghe V, Houlihan C, Berdunisov V, Taylor M, Taylor SJC, Griffiths C, Eldridge S, Walton R. Evaluating the effectiveness and cost-effectiveness of the Smoking Treatment Optimisation in Pharmacies (STOP) intervention: protocol for a cluster randomised controlled trial. Trials 2019; 20:337. [PMID: 31182134 PMCID: PMC6558670 DOI: 10.1186/s13063-019-3368-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/15/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND NHS community pharmacies provide effective smoking cessation services; however, there is scope for increasing throughput and improving quit rates. This trial examines whether the Smoking Treatment Optimisation in Pharmacies (STOP) intervention can improve smoker engagement to increase service throughput, retention and quitting. METHODS This study is a pragmatic, cluster randomised controlled trial in 60 pharmacies in England and Wales. All workers in intervention pharmacies are offered STOP training while control pharmacies provide usual care. The STOP intervention, based on behavioural and organisational theories, comprises educational sessions for staff and environmental prompts in the pharmacy. Intervention fidelity is assessed by actors visiting pharmacies posing as smokers. The primary outcome is throughput, defined as the number of smokers who join the programme, set a firm quit date and undergo at least one stop smoking treatment session, and is measured using routinely collected data. Secondary outcomes include retention and quit rates at 4 weeks and continuous abstinence at 6 months verified by salivary cotinine. Cost-effectiveness is estimated using quality-adjusted life years and the probability that the intervention is effective at different levels of willingness to pay is calculated. DISCUSSION The trial will generate evidence to inform the public health smoking cessation strategy in England and Wales, and may help to shape service commissioning decisions. The STOP intervention model may help inform the undertaking of a range of health behaviour change tasks in community pharmacies. TRIAL REGISTRATION ClinicalTrials.gov, ISRCTN16351033. Retrospectively registered on 21 March 2017.
Collapse
Affiliation(s)
- Ratna Sohanpal
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Jumbe
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Wai-Yee James
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Liz Steed
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tammy Yau
- California Northstate University, 9700 West Taron Drive, Elk Grove, CA 95757 USA
| | - Carol Rivas
- Institute of Education, University College London, London, UK
| | - Vichithranie Madurasinghe
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Colin Houlihan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vlad Berdunisov
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthew Taylor
- York Health Economics Consortium, University of York, York, UK
| | - Stephanie J. C. Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert Walton
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
9
|
Pennington B, Filby A, Owen L, Taylor M. Smoking Cessation: A Comparison of Two Model Structures. PHARMACOECONOMICS 2018; 36:1101-1112. [PMID: 29736894 DOI: 10.1007/s40273-018-0657-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Most economic evaluations of smoking cessation interventions have used cohort state-transition models. Discrete event simulations (DESs) have been proposed as a superior approach. OBJECTIVE We developed a state-transition model and a DES using the discretely integrated condition event (DICE) framework and compared the cost-effectiveness results. We performed scenario analysis using the DES to explore the impact of alternative assumptions. METHODS The models estimated the costs and quality-adjusted life years (QALYs) for the intervention and comparator from the perspective of the UK National Health Service and Personal Social Services over a lifetime horizon. The models considered five comorbidities: chronic obstructive pulmonary disease, myocardial infarction, coronary heart disease, stroke and lung cancer. The state-transition model used prevalence data, and the DES used incidence. The costs and utility inputs were the same between two models and consistent with those used in previous analyses for the National Institute for Health and Care Excellence. RESULTS In the state-transition model, the intervention produced an additional 0.16 QALYs at a cost of £540, leading to an incremental cost-effectiveness ratio (ICER) of £3438. The comparable DES scenario produced an ICER of £5577. The ICER for the DES increased to £18,354 when long-term relapse was included. CONCLUSIONS The model structures themselves did not influence smoking cessation cost-effectiveness results, but long-term assumptions did. When there is variation in long-term predictions between interventions, economic models need a structure that can reflect this.
Collapse
Affiliation(s)
- Becky Pennington
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK.
| | - Alex Filby
- York Health Economics Consortium, Enterprise House, University of York, Heslington, York, YO10 5NQ, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK
| | - Matthew Taylor
- York Health Economics Consortium, Enterprise House, University of York, Heslington, York, YO10 5NQ, UK
| |
Collapse
|
10
|
Loreto AR, Carvalho CFC, Frallonardo FP, Ismael F, Andrade AGD, Castaldelli-Maia JM. Smoking Cessation Treatment for Patients With Mental Disorders Using CBT and Combined Pharmacotherapy. J Dual Diagn 2017; 13:238-246. [PMID: 28489501 DOI: 10.1080/15504263.2017.1328149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of this study was to investigate smoking treatment effectiveness and retention in a population with and without mental disorders (MD). Participants received cognitive behavioral therapy (CBT) plus nicotine patch alone or in combination with other medications (i.e., gum, bupropion, or nortriptyline) for smoking cessation treatment in a Brazilian Psychosocial Care Center unit (CAPS), taking into account sociodemographics and smoking profile covariates. METHODS The study involved comparison of treatment success (seven-day point prevalence abstinence at the end of the treatment) and retention (presence of the individual in all of the four medical consultations and six group sessions) in two subsamples of patients with MD (n = 267) and without MD (n = 397) who were included in a six-week treatment provided by a CAPS from 2007 to 2013. The treatment protocol comprised group CBT and pharmacotherapy (nicotine patches, nicotine gums, and bupropion and nortriptyline available, prescribed by psychiatrists). RESULTS Within patients with MD, CBT plus nicotine patch plus bupropion (aOR = 2.00, 95% CI [1.14, 3.50], p = .015) and CBT plus nicotine patch plus gum (aOR = 2.10, 95% CI [1.04, 4.23], p = .036) were associated with treatment success. Within patients without MD, female gender (aOR = 0.60, 95% CI [0.37, 0.95], p = .031) and lower Heaviness of Smoking Index score (aOR = 0.80, 95% CI [0.65, 0.99], p = .048) were associated with treatment success. No variable was associated with dropout or retention within patients with or without MD. CONCLUSION Our findings support the use of CBT plus nicotine patch plus bupropion as well as CBT plus nicotine patch plus gum in samples with high rates of medical, psychiatric, and addiction disorders. These findings support those of previous studies in the general population. Pharmacological treatment associated with group CBT based on cognitive-behavioral concepts and combined with ongoing MD treatment seems to be the best option for smoking cessation treatment among patients with MD. Units that deal with patients with MD, such as CAPS in Brazil, should be encouraged to treat smoking addiction in this population. Future studies should investigate retention rates in other samples of patients with MD.
Collapse
Affiliation(s)
- Aline Rodrigues Loreto
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil
| | | | - Fernanda Piotto Frallonardo
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil.,c ABC Center for Mental Health Studies , Santo André , São Paulo , Brazil
| | - Flavia Ismael
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil.,c ABC Center for Mental Health Studies , Santo André , São Paulo , Brazil
| | - Arthur Guerra de Andrade
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil.,c ABC Center for Mental Health Studies , Santo André , São Paulo , Brazil.,d Department of Psychiatry , Medical School, University of São Paulo , São Paulo , São Paulo , Brazil
| | - João Maurício Castaldelli-Maia
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil.,b Clima Clinic , São Paulo , SP , Brazil.,c ABC Center for Mental Health Studies , Santo André , São Paulo , Brazil.,d Department of Psychiatry , Medical School, University of São Paulo , São Paulo , São Paulo , Brazil
| |
Collapse
|
11
|
Orton S, Coleman T, Coleman-Haynes T, Ussher M. Predictors of Postpartum Return to Smoking: A Systematic Review. Nicotine Tob Res 2017; 20:665-673. [DOI: 10.1093/ntr/ntx163] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/19/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Sophie Orton
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tom Coleman-Haynes
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St. Georges, University of London, London, UK
| |
Collapse
|
12
|
Berg ML, Cheung KL, Hiligsmann M, Evers S, de Kinderen RJA, Kulchaitanaroaj P, Pokhrel S. Model-based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review. Addiction 2017; 112:946-967. [PMID: 28060453 PMCID: PMC5434798 DOI: 10.1111/add.13748] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/06/2016] [Accepted: 12/30/2016] [Indexed: 12/04/2022]
Abstract
AIMS To identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context. METHODS A systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, National Health Service (NHS) Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA). The checklist-based quality of the included studies and transferability scores was based on the European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not original research, not a model-based economic evaluation, that did not consider adult population and not from a high-income country were excluded. FINDINGS Among the 64 economic evaluations included in the review, the state-transition Markov model was the most frequently used method (n = 30/64), with quality adjusted life years (QALY) being the most frequently used outcome measure in a life-time horizon. A small number of the included studies (13 of 64) were eligible for EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97, with an average score of 0.75. The average score per section was 0.69 (range = 0.35-0.92). The relative transferability of the studies could not be established due to a limitation present in the EURONHEED method. CONCLUSION All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context.
Collapse
Affiliation(s)
- Marrit L. Berg
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Kei Long Cheung
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Reina J. A. de Kinderen
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | | | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| |
Collapse
|
13
|
Hoogenveen RT, Boshuizen HC, Engelfriet PM, van Baal PHM. You Only Die Once: Accounting for Multi-Attributable Mortality Risks in Multi-Disease Models for Health-Economic Analyses. Med Decis Making 2016; 37:403-414. [DOI: 10.1177/0272989x16658661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Mortality rates in Markov models, as used in health economic studies, are often estimated from summary statistics that allow limited adjustment for confounders. If interventions are targeted at multiple diseases and/or risk factors, these mortality rates need to be combined in a single model. This requires them to be mutually adjusted to avoid ‘double counting’ of mortality. We present a mathematical modeling approach to describe the joint effect of mutually dependent risk factors and chronic diseases on mortality in a consistent manner. Most importantly, this approach explicitly allows the use of readily available external data sources. An additional advantage is that existing models can be smoothly expanded to encompass more diseases/risk factors. To illustrate the usefulness of this method and how it should be implemented, we present a health economic model that links risk factors for diseases to mortality from these diseases, and describe the causal chain running from these risk factors (e.g., obesity) through to the occurrence of disease (e.g., diabetes, CVD) and death. Our results suggest that these adjustment procedures may have a large impact on estimated mortality rates. An improper adjustment of the mortality rates could result in an underestimation of disease prevalence and, therefore, disease costs.
Collapse
Affiliation(s)
- Rudolf T. Hoogenveen
- National Institute of Public Health and the Environment, Expertise Center for Methodology and Information Services, Bilthoven, the Netherlands (RTH, HCB, PME)
- Erasmus University Rotterdam, institute of Health Policy & Management, Rotterdam, Netherlands (PHMV)
| | - Hendriek C. Boshuizen
- National Institute of Public Health and the Environment, Expertise Center for Methodology and Information Services, Bilthoven, the Netherlands (RTH, HCB, PME)
- Erasmus University Rotterdam, institute of Health Policy & Management, Rotterdam, Netherlands (PHMV)
| | - Peter M. Engelfriet
- National Institute of Public Health and the Environment, Expertise Center for Methodology and Information Services, Bilthoven, the Netherlands (RTH, HCB, PME)
- Erasmus University Rotterdam, institute of Health Policy & Management, Rotterdam, Netherlands (PHMV)
| | - Pieter H. M. van Baal
- National Institute of Public Health and the Environment, Expertise Center for Methodology and Information Services, Bilthoven, the Netherlands (RTH, HCB, PME)
- Erasmus University Rotterdam, institute of Health Policy & Management, Rotterdam, Netherlands (PHMV)
| |
Collapse
|
14
|
Barnett PG, Wong W, Jeffers A, Hall SM, Prochaska JJ. Cost-effectiveness of smoking cessation treatment initiated during psychiatric hospitalization: analysis from a randomized, controlled trial. J Clin Psychiatry 2015; 76:e1285-91. [PMID: 26528651 PMCID: PMC4988964 DOI: 10.4088/jcp.14m09016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 10/15/2014] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We examined the cost-effectiveness of smoking cessation treatment for psychiatric inpatients. METHOD Smokers, regardless of intention to quit, were recruited during psychiatric hospitalization and randomized to receive stage-based smoking cessation services or usual aftercare. Smoking cessation services, quality of life, and biochemically verified abstinence from cigarettes were assessed during 18 months of follow-up. A Markov model of cost-effectiveness over a lifetime horizon was constructed using trial findings and parameters obtained in a review of the literature on quit and relapse rates and the effect of smoking on health care cost, quality of life, and mortality. RESULTS Among 223 smokers randomized between 2006 and 2008, the mean cost of smoking cessation services was $189 in the experimental treatment group and $37 in the usual care condition (P < .001). At the end of follow-up, 18.75% of the experimental group was abstinent from cigarettes, compared to 6.80% abstinence in the usual care group (P < .05). The model projected that the intervention added $43 in lifetime cost and generated 0.101 additional quality-adjusted life-years (QALYs), an incremental cost-effectiveness ratio of $428 per QALY. Probabilistic sensitivity analysis found the experimental intervention was cost-effective against the acceptance criteria of $50,000/QALY in 99.0% of the replicates. CONCLUSIONS A cessation intervention for smokers identified in psychiatric hospitalization did not result in higher mental health care costs in the short-run and was highly cost-effective over the long-term. The stage-based intervention was a feasible and cost-effective way of addressing the high smoking prevalence in persons with serious mental illness. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00136812.
Collapse
Affiliation(s)
- Paul G. Barnett
- Department of Psychiatry, University of California, San Francisco,Veterans Affairs Health Economics Resource Center, Menlo Park, CA,Department of Health Research and Policy, Stanford University, Palo Alto, CA
| | - Wynnie Wong
- Department of Psychiatry, University of California, San Francisco
| | - Abra Jeffers
- Department of Management Science & Engineering, Stanford University, Stanford, CA
| | - Sharon M. Hall
- Department of Psychiatry, University of California, San Francisco
| | - Judith J. Prochaska
- Department of Psychiatry, University of California, San Francisco,Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
| |
Collapse
|
15
|
Ekpu VU, Brown AK. The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence. Tob Use Insights 2015; 8:1-35. [PMID: 26242225 PMCID: PMC4502793 DOI: 10.4137/tui.s15628] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/24/2014] [Accepted: 08/28/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Tobacco smoking is the cause of many preventable diseases and premature deaths in the UK and around the world. It poses enormous health- and non-health-related costs to the affected individuals, employers, and the society at large. The World Health Organization (WHO) estimates that, globally, smoking causes over US$500 billion in economic damage each year. OBJECTIVES This paper examines global and UK evidence on the economic impact of smoking prevalence and evaluates the effectiveness and cost effectiveness of smoking cessation measures. STUDY SELECTION SEARCH METHODS We used two major health care/economic research databases, namely PubMed and the National Institute for Health Research (NIHR) database that contains the British National Health Service (NHS) Economic Evaluation Database; Cochrane Library of systematic reviews in health care and health policy; and other health-care-related bibliographic sources. We also performed hand searching of relevant articles, health reports, and white papers issued by government bodies, international health organizations, and health intervention campaign agencies. SELECTION CRITERIA The paper includes cost-effectiveness studies from medical journals, health reports, and white papers published between 1992 and July 2014, but included only eight relevant studies before 1992. Most of the papers reviewed reported outcomes on smoking prevalence, as well as the direct and indirect costs of smoking and the costs and benefits of smoking cessation interventions. We excluded papers that merely described the effectiveness of an intervention without including economic or cost considerations. We also excluded papers that combine smoking cessation with the reduction in the risk of other diseases. DATA COLLECTION AND ANALYSIS The included studies were assessed against criteria indicated in the Cochrane Reviewers Handbook version 5.0.0. OUTCOMES ASSESSED IN THE REVIEWPrimary outcomes of the selected studies are smoking prevalence, direct and indirect costs of smoking, and the costs and benefits of smoking cessation interventions (eg, "cost per quitter", "cost per life year saved", "cost per quality-adjusted life year gained," "present value" or "net benefits" from smoking cessation, and "cost savings" from personal health care expenditure). MAIN RESULTS The main findings of this study are as follows: The costs of smoking can be classified into direct, indirect, and intangible costs. About 15% of the aggregate health care expenditure in high-income countries can be attributed to smoking. In the US, the proportion of health care expenditure attributable to smoking ranges between 6% and 18% across different states. In the UK, the direct costs of smoking to the NHS have been estimated at between £2.7 billion and £5.2 billion, which is equivalent to around 5% of the total NHS budget each year. The economic burden of smoking estimated in terms of GDP reveals that smoking accounts for approximately 0.7% of China's GDP and approximately 1% of US GDP. As part of the indirect (non-health-related) costs of smoking, the total productivity losses caused by smoking each year in the US have been estimated at US$151 billion.The costs of smoking notwithstanding, it produces some potential economic benefits. The economic activities generated from the production and consumption of tobacco provides economic stimulus. It also produces huge tax revenues for most governments, especially in high-income countries, as well as employment in the tobacco industry. Income from the tobacco industry accounts for up to 7.4% of centrally collected government revenue in China. Smoking also yields cost savings in pension payments from the premature death of smokers.Smoking cessation measures could range from pharmacological treatment interventions to policy-based measures, community-based interventions, telecoms, media, and technology (TMT)-based interventions, school-based interventions, and workplace interventions.The cost per life year saved from the use of pharmacological treatment interventions ranged between US$128 and US$1,450 and up to US$4,400 per quality-adjusted life years (QALYs) saved. The use of pharmacotherapies such as varenicline, NRT, and Bupropion, when combined with GP counseling or other behavioral treatment interventions (such as proactive telephone counseling and Web-based delivery), is both clinically effective and cost effective to primary health care providers.Price-based policy measures such as increase in tobacco taxes are unarguably the most effective means of reducing the consumption of tobacco. A 10% tax-induced cigarette price increase anywhere in the world reduces smoking prevalence by between 4% and 8%. Net public benefits from tobacco tax, however, remain positive only when tax rates are between 42.9% and 91.1%. The cost effectiveness ratio of implementing non-price-based smoking cessation legislations (such as smoking restrictions in work places, public places, bans on tobacco advertisement, and raising the legal age of smokers) range from US$2 to US$112 per life year gained (LYG) while reducing smoking prevalence by up to 30%-82% in the long term (over a 50-year period).Smoking cessation classes are known to be most effective among community-based measures, as they could lead to a quit rate of up to 35%, but they usually incur higher costs than other measures such as self-help quit-smoking kits. On average, community pharmacist-based smoking cessation programs yield cost savings to the health system of between US$500 and US$614 per LYG.Advertising media, telecommunications, and other technology-based interventions (such as TV, radio, print, telephone, the Internet, PC, and other electronic media) usually have positive synergistic effects in reducing smoking prevalence especially when combined to deliver smoking cessation messages and counseling support. However, the outcomes on the cost effectiveness of TMT-based measures have been inconsistent, and this made it difficult to attribute results to specific media. The differences in reported cost effectiveness may be partly attributed to varying methodological approaches including varying parametric inputs, differences in national contexts, differences in advertising campaigns tested on different media, and disparate levels of resourcing between campaigns. Due to its universal reach and low implementation costs, online campaign appears to be substantially more cost effective than other media, though it may not be as effective in reducing smoking prevalence.School-based smoking prevalence programs tend to reduce short-term smoking prevalence by between 30% and 70%. Total intervention costs could range from US$16,400 to US$580,000 depending on the scale and scope of intervention. The cost effectiveness of school-based programs show that one could expect a saving of approximately between US$2,000 and US$20,000 per QALY saved due to averted smoking after 2-4 years of follow-up.Workplace-based interventions could represent a sound economic investment to both employers and the society at large, achieving a benefit-cost ratio of up to 8.75 and generating 12-month employer cost savings of between $150 and $540 per nonsmoking employee. Implementing smoke-free workplaces would also produce myriads of new quitters and reduce the amount of cigarette consumption, leading to cost savings in direct medical costs to primary health care providers. Workplace interventions are, however, likely to yield far greater economic benefits over the long term, as reduced prevalence will lead to a healthier and more productive workforce. CONCLUSIONS We conclude that the direct costs and externalities to society of smoking far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes (ie, in terms of a healthy population and a productive workforce). There are enormous differences in the application and economic measurement of smoking cessation measures across various types of interventions, methodologies, countries, economic settings, and health care systems, and these may have affected the comparability of the results of the studies reviewed. However, on the balance of probabilities, most of the cessation measures reviewed have not only proved effective but also cost effective in delivering the much desired cost savings and net gains to individuals and primary health care providers.
Collapse
Affiliation(s)
- Victor U Ekpu
- Adam Smith Business School (Economics Division), University of Glasgow, Glasgow, UK
| | - Abraham K Brown
- Nottingham Business School (Marketing Division), Nottingham Trent University, Nottingham, UK
| |
Collapse
|
16
|
Agboola SA, Coleman T, McNeill A, Leonardi-Bee J. Abstinence and relapse among smokers who use varenicline in a quit attempt-a pooled analysis of randomized controlled trials. Addiction 2015; 110:1182-93. [PMID: 25846123 DOI: 10.1111/add.12941] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/16/2014] [Accepted: 03/31/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Varenicline increases the likelihood of long-term abstinence following a quit attempt. It has been suggested that (1) part of its benefit arises from 'recruiting into abstinence' smokers who are not able to stop on the target quit date and (2) there may be a higher rate of relapse after treatment. This study addressed these issues. METHODS Meta-analyses of data from randomized controlled trials (RCTs) of varenicline identified from the 2012 Cochrane review of nicotine receptor partial agonists for smoking cessation were used to compare the abstinence and relapse patterns on active drug and placebo. Studies of varenicline compared with placebo in adult daily smokers with longest follow-up at either 6 or 12 months and with at least three follow-ups in the first month were included. Biochemically verified abstinence rates at each of six follow-up time-points (2, 3, 4, 12, 24 and 52 weeks) were pooled for studies reporting point prevalence abstinence. Biochemically verified abstinence rates at three follow-up time-periods (9-12 weeks, 9-24 weeks and 9-52 weeks) were pooled for studies reporting continuous abstinence. Random effects meta-analysis was used to estimate pooled proportions with 95% confidence intervals. RESULTS Nineteen RCTs were included. In varenicline-treated participants, point-prevalence abstinence increased by 22 percentage points from week 2 [32%: 95% confidence interval (CI) = 25-40%] to week 12 (54%: 95% CI = 48-61%). The increase was 8 percentage points in the placebo group: 16% (95% CI = 11-21%) to 24% (95% CI = 17-33%). In varenicline-treated participants the relapse from weeks 9-12 to week 52 was 55%: 49% abstinent in weeks 9-12 (95% CI = 45-53%) versus 22% at week 52 (95% CI = 19-25%). In placebo-treated participants it was 53%: 17% (95% CI = 13-25%) in weeks 9-12 versus 8% (95% CI = 6-12%) at week 52. CONCLUSIONS Varenicline recruits smokers into abstinence following the target quit date to a greater extent than placebo. Relapse rates from end of treatment to 52 weeks are similar in varenicline- and placebo-treated smokers.
Collapse
Affiliation(s)
- Shade A Agboola
- UK Centre for Tobacco &and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies and NIHR School for Primary Care Research, Division of Primary Care, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, Addictions Department, Institute of Psychiatry King's College London, SE5 8AF, UK
| | - Jo Leonardi-Bee
- UK Centre for Tobacco &and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, NG5 1PB, UK
| |
Collapse
|
17
|
Feirman SP, Donaldson E, Glasser AM, Pearson JL, Niaura R, Rose SW, Abrams DB, Villanti AC. Mathematical Modeling in Tobacco Control Research: Initial Results From a Systematic Review. Nicotine Tob Res 2015; 18:229-42. [PMID: 25977409 DOI: 10.1093/ntr/ntv104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models. METHODS We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies. RESULTS The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies. CONCLUSIONS This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work.
Collapse
Affiliation(s)
- Shari P Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elisabeth Donaldson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ray Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Shyanika W Rose
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
| |
Collapse
|
18
|
Barnett PG, Jeffers A, Smith MW, Chow BK, McFall M, Saxon AJ. Cost-Effectiveness of Integrating Tobacco Cessation Into Post-Traumatic Stress Disorder Treatment. Nicotine Tob Res 2015; 18:267-74. [PMID: 25943761 DOI: 10.1093/ntr/ntv094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/24/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION We examined the cost-effectiveness of smoking cessation integrated with treatment for post-traumatic stress disorder (PTSD). METHODS Smoking veterans receiving care for PTSD (N = 943) were randomized to care integrated with smoking cessation versus referral to a smoking cessation clinic. Smoking cessation services, health care cost and utilization, quality of life, and biochemically-verified abstinence from cigarettes were assessed over 18-months of follow-up. Clinical outcomes were combined with literature on changes in smoking status and the effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness over a lifetime horizon. We discounted cost and outcomes at 3% per year and report costs in 2010 US dollars. RESULTS The mean of smoking cessation services cost was $1286 in those randomized to integrated care and $551 in those receiving standard care (P < .001). There were no significant differences in the cost of mental health services or other care. After 12 months, prolonged biochemically verified abstinence was observed in 8.9% of those randomized to integrated care and 4.5% of those randomized to standard care (P = .004). The model projected that Integrated Care added $836 in lifetime cost and generated 0.0259 quality adjusted life years (QALYs), an incremental cost-effectiveness ratio of $32 257 per QALY. It was 86.0% likely to be cost-effective compared to a threshold of $100 000/QALY. CONCLUSIONS Smoking cessation integrated with treatment for PTSD was cost-effective, within a broad confidence region, but less cost-effective than most other smoking cessation programs reported in the literature.
Collapse
Affiliation(s)
- Paul G Barnett
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA; Treatment Research Center, Department of Psychiatry, University of California, San Francisco, CA;
| | - Abra Jeffers
- Department of Management Science and Engineering, Stanford University, Stanford, CA
| | | | - Bruce K Chow
- Veterans Affairs Cooperative Studies Program Coordinating Center, Palo Alto, CA
| | - Miles McFall
- Veterans Affairs Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| |
Collapse
|
19
|
Aubin HJ, Luquiens A, Berlin I. Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice. Br J Clin Pharmacol 2014; 77:324-36. [PMID: 23488726 PMCID: PMC4014023 DOI: 10.1111/bcp.12116] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 02/11/2013] [Indexed: 11/30/2022] Open
Abstract
Strategies for assisting smoking cessation include behavioural counselling to enhance motivation and to support attempts to quit and pharmacological intervention to reduce nicotine reinforcement and withdrawal from nicotine. Three drugs are currently used as first line pharmacotherapy for smoking cessation, nicotine replacement therapy, bupropion and varenicline. Compared with placebo, the drug effect varies from 2.27 (95% CI 2.02, 2.55) for varenicline, 1.69 (95% CI 1.53, 1.85) for bupropion and 1.60 (95% CI 1.53, 1.68) for any form of nicotine replacement therapy. Despite some controversy regarding the safety of bupropion and varenicline, regulatory agencies consider these drugs as having a favourable benefit/risk profile. However, given the high rate of psychiatric comorbidity in dependent smokers, practitioners should closely monitor patients for neuropsychiatric symptoms. Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments and issues related to smoking cessation in special populations such as persons with psychiatric comorbidity and pregnant and adolescent smokers.
Collapse
Affiliation(s)
- Henri-Jean Aubin
- Centre d'enseignement, de recherche, et de traitement des addictions, Hôpital Paul Brousse, Pars-Sud 11 UniversityINSERM U669, 94800, Villejuif, France
| | - Amandine Luquiens
- Centre d'enseignement, de recherche, et de traitement des addictions, Hôpital Paul Brousse, Pars-Sud 11 UniversityINSERM U669, 94800, Villejuif, France
| | - Ivan Berlin
- Département de Pharmacologie, Université P.&M. Curie, Faculté de médecine, Hôpital Pitié-Salpêtrière75013, Paris, France
| |
Collapse
|
20
|
Barnett PG, Wong W, Jeffers A, Munoz R, Humfleet G, Hall S. Cost-effectiveness of extended cessation treatment for older smokers. Addiction 2014; 109:314-22. [PMID: 24329972 PMCID: PMC4020783 DOI: 10.1111/add.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/21/2012] [Accepted: 10/24/2013] [Indexed: 11/30/2022]
Abstract
AIMS We examined the cost-effectiveness of extended smoking cessation treatment in older smokers. DESIGN Participants who completed a 12-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy. SETTING A free-standing smoking cessation clinic. PARTICIPANTS A total of 402 smokers aged 50 years and older were recruited from the community. MEASUREMENTS The trial measured biochemically verified abstinence from cigarettes after 2 years and the quantity of smoking cessation services utilized. Trial findings were combined with literature on changes in smoking status and the age- and gender-adjusted effect of smoking on health-care cost, mortality and quality of life over the long term in a Markov model of cost-effectiveness over a lifetime horizon. FINDINGS The addition of extended cognitive behavioral therapy added $83 in smoking cessation services cost [P = 0.012, confidence interval (CI) = $22-212]. At the end of follow-up, cigarette abstinence rates were 50.0% with extended cognitive behavioral therapy and 37.2% without this therapy (P < 0.05, odds ratio 1.69, CI 1.18-2.54). The model-based incremental cost-effectiveness ratio was $6324 per quality-adjusted life year (QALY). Probabilistic sensitivity analysis found that the additional $947 in lifetime cost of the intervention had a 95% confidence interval of -$331 to 2081; the 0.15 additional QALYs had a confidence interval of 0.035-0.280, and that the intervention was cost-effective against a $50 000/QALY acceptance criterion in 99.6% of the replicates. Extended nicotine replacement therapy was not cost-effective. CONCLUSIONS Adding extended cognitive behavior therapy to standard cessation treatment was cost-effective. Further intensification of treatment may be warranted.
Collapse
Affiliation(s)
- Paul G. Barnett
- Department of Psychiatry, University of California, San Francisco
,Veterans Affairs Health Economics Resource Center and Stanford University
| | - Wynnie Wong
- Department of Psychiatry, University of California, San Francisco
| | - Abra Jeffers
- Veterans Affairs Health Economics Resource Center and Stanford University
| | - Ricardo Munoz
- Department of Psychiatry, University of California, San Francisco
,Palo Alto University
| | - Gary Humfleet
- Department of Psychiatry, University of California, San Francisco
| | - Sharon Hall
- Department of Psychiatry, University of California, San Francisco
| |
Collapse
|
21
|
Castaldelli-Maia JM, Carvalho CFC, Armentano F, Frallonardo FP, Alves TCDTF, Andrade AGD, Nicastri S. Outcome predictors of smoking cessation treatment provided by an addiction care unit between 2007 and 2010. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:338-46. [DOI: 10.1590/1516-4446-2012-0907] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 01/22/2013] [Indexed: 11/21/2022]
|
22
|
Higgins GA, Sellers EM, Fletcher PJ. From obesity to substance abuse: therapeutic opportunities for 5-HT2C receptor agonists. Trends Pharmacol Sci 2013; 34:560-70. [PMID: 24041919 DOI: 10.1016/j.tips.2013.08.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/26/2013] [Accepted: 08/02/2013] [Indexed: 12/25/2022]
Abstract
The recent US Food and Drug Administration (FDA) approval of the serotonin (5-hydroxytryptamine, 5-HT) 5-HT2C receptor agonist lorcaserin for the treatment of obesity represents a new therapeutic drug class available to the clinic. Preclinical evidence supports the potential for this drug class to treat other related conditions such as substance abuse. In the present article we review this evidence and further suggest that overlapping neurobiological systems may contribute to an anti-addictive and anti-obesity profile. The availability of selective 5-HT2C agonists provides an opportunity to evaluate their potential as treatments for nicotine dependence or psychostimulant abuse, conditions for which there is significant medical need but only limited available treatment options.
Collapse
Affiliation(s)
- Guy A Higgins
- InterVivo Solutions Inc, 120 Carlton Street, Toronto, ON M5A 4K2, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | | | | |
Collapse
|
23
|
Kennelly RP, Subramaniam T, Egan LJ, Joyce MR. Smoking and Crohn's disease: active modification of an independent risk factor (education alone is not enough). J Crohns Colitis 2013; 7:631-5. [PMID: 23036508 DOI: 10.1016/j.crohns.2012.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/12/2012] [Accepted: 08/29/2012] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Smoking can induce the onset of Crohn's disease in genetically susceptible patients and may accelerate progression and disease severity. There is a paucity of information as to patient knowledge of the impact of smoking on disease progression. The aim of this study was to assess patient awareness, initiate smoking cessation therapy and monitor the effectiveness of an active smoking cessation programme in patients with Crohn's disease. METHODS All patients with a diagnosis of Crohn's disease over a ten year period were identified from a prospectively managed database. Details of smoking history and patient knowledge of the link between Crohn's disease and smoking were collected through a telephone questionnaire. Current smokers who wished to quit were enrolled in a smoking cessation programme and followed prospectively for 12 months. RESULTS 340 patients were identified with 281 eligible for inclusion. 181 patients agreed to a telephone survey (64.4% patient uptake). Smokers had an increased incidence of surgical intervention (OR 2.2; CI 1.02, 4.78 P=0.043). Awareness of the link between smoking and Crohn's disease was highest in the current smoking cohort and lowest in the non-smoking cohort (CS:NS; 79.5%:43% p<0.001). 29% of patients with a smoking history had previously been offered smoking cessation therapy. 77% of current smokers opted for smoking cessation therapy. At 6 months 53% of these patients remained smoke free and 37% at 12 months. CONCLUSION In patients with Crohn's disease, information alone is ineffective at achieving smoking cessation. Good cessation rates are achievable if information is supported by active smoking cessation therapy.
Collapse
Affiliation(s)
- Rory P Kennelly
- Department of Colorectal Surgery, University College Hospital Galway, Newcastle, Co. Galway, Ireland.
| | | | | | | |
Collapse
|
24
|
Le Houezec J, Aubin HJ. Pharmacotherapies and harm-reduction options for the treatment of tobacco dependence. Expert Opin Pharmacother 2013; 14:1959-67. [PMID: 23978314 DOI: 10.1517/14656566.2013.818978] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Tobacco dependence, a chronic relapsing condition, requires repeated interventions and multiple attempts to quit. AREAS COVERED Strategies for assisting smoking cessation include behavioural counselling and pharmacotherapy. Three drugs are currently used as first-line pharmacotherapy: nicotine replacement therapy (NRT), bupropion and varenicline. Compared to placebo, the drug effect varies from RR = 2.27 for varenicline, to 1.69 for bupropion, and 1.60 for any form of NRT. Cytisine (similar to varenicline) has a RR = 3.98 compared to placebo (two trials). Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments. EXPERT OPINION Effective medications exist, and clinicians should encourage and offer treatment to every smoker. However, most smokers try to quit by themselves, with only about 3% quitting successfully each year. Alternative interventions are needed. Harm reduction has not received much support to date. Safer alternative to tobacco smoking (smoke-free products, long-term use of cessation drugs, or electronic cigarettes) could save lives and reduce the burden of tobacco-related deaths and diseases. Despite some encouragement to develop a research agenda for e-cigarettes, particularly on the safety issues, too little attention has been brought to this area of research.
Collapse
Affiliation(s)
- Jacques Le Houezec
- Consultant in Public Health, Tobacco dependence, Amzer Glas , 176 rue de Brest, 35000 Rennes , France +332 99 33 72 67 ;
| | | |
Collapse
|
25
|
Song F, Holland R, Barton GR, Bachmann M, Blyth A, Maskrey V, Aveyard P, Sutton S, Leonardi-Bee J, Brandon TH. Self-help materials for the prevention of smoking relapse: study protocol for a randomized controlled trial. Trials 2012; 13:69. [PMID: 22647290 PMCID: PMC3480895 DOI: 10.1186/1745-6215-13-69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 04/23/2012] [Indexed: 11/16/2022] Open
Abstract
Background Most people who stop smoking successfully for a few weeks will return to smoking again in the medium term. There are few effective interventions to prevent this relapse and none used routinely in clinical practice. A previous exploratory meta-analysis suggested that self-help booklets may be effective but requires confirmation. This trial aims to evaluate the effectiveness and cost-effectiveness of a set of self-help educational materials to prevent smoking relapse in the National Health Service (NHS) Stop Smoking Service. Methods/design This is an open, randomized controlled trial. The target population is carbon monoxide (CO) verified quitters at four weeks in the NHS stop smoking clinic (total sample size N = 1,400). The experimental intervention tested is a set of eight revised Forever Free booklets, including an introduction booklet and more extensive information on all important issues for relapse prevention. The control intervention is a leaflet that has no evidence to suggest it is effective but is currently given to some patients using NHS stop smoking services. Two follow-up telephone interviews will be conducted at three and 12 months after the quit date. The primary outcome will be prolonged abstinence from months four to 12 with no more than five lapses, confirmed by a CO test at the 12-month assessment. The secondary outcomes will be seven-day self-report point prevalence abstinence at three months and seven-day biochemically confirmed point prevalence abstinence at 12 months. To assess cost-effectiveness, costs will be estimated from a health service perspective and the EQ-5D will be used to estimate the QALY (Quality Adjusted Life Year) gain associated with each intervention. The comparison of smoking abstinence rates (and any other binary outcomes) between the two trial arms will be carried out using odds ratio as the outcome statistic and other related statistical tests. Exploratory subgroup analyses, including logistic regression analyses with interaction terms, will be conducted to investigate possible effect-modifying variables. Discussion The possible effect of self-help educational materials for the prevention of smoking relapse has important public health implications. Trial registration Current Controlled Trials ISRCTN36980856
Collapse
Affiliation(s)
- Fujian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich NR4 7TJ, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|