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Jiménez-Ruiz CA, Martín V, Alsina-Restoy X, Granda-Orive JI, de Higes-Martínez E, García-Rueda M, Genovés-Crespo M, López-García C, Lorza-Blasco JJ, Márquez FL, Ramos-Pinedo Á, Riesco-Miranda JA, Signes-Costa J, Solano-Reina S, Vaquero-Lozano P, Rejas J. Cost–benefit analysis of funding smoking cessation before surgery. Br J Surg 2020; 107:978-994. [DOI: 10.1002/bjs.11506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/18/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Smoking at the time of surgery is associated with postoperative complications. Quitting smoking before surgery is linked to fewer complications during the hospital stay. This work analysed whether a smoking cessation intervention before surgery is economically worthwhile when funded by the National Health System (NHS) in Spain.
Methods
The economic analysis considered costs and benefits of the intervention to the NHS for the year 2016. The population who would benefit comprised adult smokers who were ready to quit and for whom surgery requiring admission to hospital was planned. The intervention, a combination of medical counselling and use of a smoking cessation drug which should occur 12 weeks before surgery, considered one attempt only to quit smoking. Benefits were costs avoided by averting postoperative complications if cessation was successful. The analysis compared the net economic outcome (benefit minus cost of intervention) and the return on investment, for intervention funded by the NHS versus the current situation without funding.
Results
Smoking cessation increased by 21·7 per cent with funding; the rate was 32·5 per cent when funded versus 10·7 per cent without funding, producing 9611 extra quitters. The cost per averted smoker was €1753 with a benefit of €503, achieving a net economic benefit of €4·8 million per year. Given the annual cost of the intervention (€17·4 million, of which €5·6 million (32·5 per cent) represents drugs), the return on investment was 28·7 per cent annually, equivalent to €1·29 per €1 of investment.
Conclusion
From the perspective of the Spanish NHS, the benefit of funding smoking cessation before surgery, in terms of healthcare cost savings, appears to greatly outweigh the costs.
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Affiliation(s)
- C A Jiménez-Ruiz
- Specialized Tobacco Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - V Martín
- Department of Economics, University Carlos III, Madrid, Spain
| | - X Alsina-Restoy
- Department of Respiratory Medicine, Hospital Clínic, Barcelona, Spain
| | - J I Granda-Orive
- Department of Respiratory Medicine, Hospital 12 de Octubre, Madrid, Spain
| | - E de Higes-Martínez
- Department of Respiratory Medicine, Hospital Fundación Alcorcón, Alcorcón, Spain
| | - M García-Rueda
- Department of Respiratory Medicine, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - M Genovés-Crespo
- Department of Thoracic Surgery, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - J J Lorza-Blasco
- Department of Respiratory Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - F L Márquez
- Department of Respiratory Medicine, Hospital Infanta Cristina, Badajoz, Spain
| | - Á Ramos-Pinedo
- Department of Respiratory Medicine, Hospital Fundación Alcorcón, Alcorcón, Spain
| | - J A Riesco-Miranda
- Department of Respiratory Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - J Signes-Costa
- Department of Respiratory Medicine, Hospital Clínico, Valencia, Spain
| | - S Solano-Reina
- Department of Respiratory Medicine, Hospital Gregorio Marañón, Madrid, Spain
| | - P Vaquero-Lozano
- Department of Respiratory Medicine, Hospital Gregorio Marañón, Madrid, Spain
| | - J Rejas
- Department of Health Economics and Outcomes Research, Pfizer SLU, Alcobendas, Spain
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Lee LJ, Li Q, Bruno M, Emir B, Murphy B, Shah S, Reynolds M, Marchant N, Park PW. Healthcare Costs of Smokers Using Varenicline Versus Nicotine-Replacement Therapy Patch in the United States: Evidence from Real-World Practice. Adv Ther 2019; 36:365-380. [PMID: 30569324 PMCID: PMC6824348 DOI: 10.1007/s12325-018-0858-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Indexed: 12/21/2022]
Abstract
Introduction Varenicline (VAR) is an effective smoking-cessation therapy compared to the commonly used nicotine-replacement therapy patch (NRT-P). However, comparative real-world evidence on smoking-cessation therapies is limited, especially for economic outcomes. Methods Using national claims databases (2012–2016) in the United States (US), adults initiating VAR or NRT-P without use of any other smoking-cessation products were followed for up to 1 year on a quarterly basis. Outcomes included smoking-attributable (SA) (cardiovascular, diabetes, pulmonary diseases, and smoking cessation) and all-cause costs (2017 US dollars). Adjusted mean costs were estimated from multivariable regressions, with baseline characteristics and propensity scores as covariates. Annual adjusted costs were calculated from quarterly averages. Results The VAR cohort (n = 209,284) was younger (mean age 46.7 vs. 49.0 years) and had fewer comorbidities [mean Charlson Comorbidity Index (CCI): 0.8 vs. 1.6] than the NRT-P cohort (n = 34,593). After adjustment, VAR cohort had lower SA and all-cause medical costs than NRT-P cohort in Quarters 1–4 (Q1–Q4) of follow-up, and had lower SA and all-cause total costs in Q2–Q4. Annually, VAR cohort had higher SA total costs ($307) and lower all-cause costs (− $2089) than NRT-P cohort. Annual medical costs were lower in VAR cohort (− $640 for SA and − $2876 for all-cause), and pharmacy costs were higher ($762 for SA and $777 for all-cause). In adherent patients (VAR: n = 38,744; NRT-P: n = 2702), VAR patients had lower annual medical costs (− $794 for SA and − $1636 for all-cause) and higher pharmacy costs ($1175 for SA and $1269 for all-cause); differences in SA and all-cause total costs were not statistically significant between treatment groups. Conclusions Lower SA and all-cause medical costs associated with the use of VAR versus NRT-P resulted in savings in all-cause total costs and, among adherent patients, potentially offset the high pharmacy costs of VAR. Funding Pfizer, Inc. Electronic supplementary material The online version of this article (10.1007/s12325-018-0858-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren J Lee
- Health Economics and Outcomes Research, Pfizer, Inc., New York, NY, USA.
| | - Qian Li
- Data Analytics, Evidera, Bethesda, MD, USA
| | | | - Birol Emir
- Statistical Research and Data Science Center, Pfizer, Inc., New York, NY, USA
| | | | | | | | - Nick Marchant
- Health Economics and Outcomes Research, Pfizer, Inc., New York, NY, USA
| | - Peter W Park
- Medical Affairs, Pfizer, Inc., New York, NY, USA
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López Ibáñez de Aldecoa A, Cedillo Gómez S, Bruguera E, García-Portilla MP, Bobes J. Smoking Status and Cost of Illness in Patients with Depressive Disorder Based on the National Health Survey in Spain. Subst Use Misuse 2019; 54:713-723. [PMID: 30585110 DOI: 10.1080/10826084.2018.1536717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Twenty-one percent of subjects with depressive disorder (DD) smoke. This prevalence is expected to be related to healthcare resources utilization (HRU) and sick leave, thereby accounting for substantial costs to the National Health System (NHS) and to society that still need to be characterized. The objective was to estimate cost of illness in patients with DD according to their smoking status. METHODS We used the 2011/2012 National Health Survey to document HRU and lost-workday equivalents (LWDE). Men and women 18+ years old with a DD self-reported to a physician in the past 12 months were categorized into: smokers (daily smokers), former smokers, and never smokers. HRU and LWDE were computed on an annualized basis. Multivariate general linear models adjusted for sex, age, and comorbidities were applied. RESULTS Data from 1,816 subjects (381 smokers, 290 former smokers, and 1,145 never smokers) were analyzed. Smokers had higher total per patient annual costs (thousands, €3.14), and higher annual healthcare costs (€2.53) than former smokers (€2.35, p < .1; and €1.93, p < .05) and never smokers (€2.42, p < .05; and €2.06, p < .1): with excess costs of €0.79 and €0.72 for total annual costs and €0.60 and €0.47 for annual healthcare costs (p = .029 and p = .056, respectively). CONCLUSIONS Smoking DD subjects were associated with higher HRU and costs from both the societal and healthcare perspectives, when compared with former and never smokers in the Spanish general population. Supporting people with DD to quit smoking might therefore be a value-for-money health policy in Spain.
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Affiliation(s)
| | | | - Eugeni Bruguera
- c c Addictive Behaviour Unit of Psychiatry, Vall d'Hebron University Hospital , Barcelona , Spain
| | - María-Paz García-Portilla
- d d Department of Medicine , Psychiatry Area, University of Oviedo , Oviedo , Spain.,e e Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM , Oviedo , Spain
| | - Julio Bobes
- e e Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM , Oviedo , Spain.,f f Department of Medicine , Psychiatry Area, University of Oviedo , Oviedo , Spain
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Rejas-Gutiérrez J, Bruguera E, Cedillo S. Modelling a budgetary impact analysis for funding drug-based smoking cessation therapies for patients with major depressive disorder in Spain. Eur Psychiatry 2017; 45:41-49. [PMID: 28728094 DOI: 10.1016/j.eurpsy.2017.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Smoking is associated with high healthcare resource utilisation and cost to society. Patients with major depressive disorder (MDD) exhibit high susceptibility to nicotine dependence. Varenicline, bupropion and nicotine replacement therapy are all indicated for smoking cessation; however funding by the Spanish national health system (SNHS) is limited. We modelled a budgetary impact analysis (BIA) to estimate the impact of the SNHS funding drug-based therapies for smoking cessation in smokers with MDD. METHODS The BIA compared the current unfunded scenario versus a funded scenario (varenicline, bupropion, nicotine replacement therapy combined with medical follow-up and counselling) using the Spanish SNHS and societal perspectives. The BIA design was a hybrid model using a decision tree algorithm (population size: smokers with MDD) and Markov chains (smoking cessation attempts) over a 5-year horizon. Smoking cessation drug efficacy was derived from clinical trials, and smoking cessation costs avoided were taken from an analysis of the Spanish National Health Survey. Results were shown as incremental cost savings. Scenarios and threshold univariate sensitivity analyses tested model robustness. RESULTS The funded scenario resulted in an increase of 43,478 cessation attempts and 8930 fewer smokers after 5 years compared to the unfunded scenario. The cost of funding was €25.3 million and costs avoided were €26.5 million. There was a cumulative 5-year incremental cost saving of €1.2 million to Spanish society. Results were robust using alternative scenarios. CONCLUSIONS Funding smoking cessation drugs in patients with MDD is of economic benefit to Spain and could produce net savings from the third year of implementation.
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Affiliation(s)
- J Rejas-Gutiérrez
- Health Economics and Outcomes Research Department, Pfizer, S.L.U., Alcobendas (Madrid), Spain.
| | - E Bruguera
- Addictive Behaviour Unit of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Cedillo
- Trial Form Support Develop, Madrid, Spain
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Sicras-Mainar A, Rejas-Gutiérrez J, Navarro-Artieda R, Ibánez-Nolla J. Effect of smoking status on healthcare costs and resource utilization in patients with type 2 diabetes in routine clinical practice: a retrospective nested case-control economic study. Eur Addict Res 2014; 20:94-104. [PMID: 24192535 DOI: 10.1159/000355171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/13/2013] [Indexed: 11/19/2022]
Abstract
AIM To compare healthcare resource utilization and costs according to smoking status in patients with type 2 diabetes in clinical practice. METHODS A retrospective cohort nested case-control study was designed. Cases were current smokers, while 2 types of controls (former smokers and never smokers) were matched (2 controls per case) for age, sex, duration of diabetes and burden of comorbidity using data from medical records. Noninstitutionalized diabetics of both genders, aged>18 years and seen consecutively over a 5-year period before the index date, were enrolled. Analysis compared healthcare resource utilization, loss of productivity due to sick leave and corresponding costs. RESULTS In total, 2,490 medical records were analyzed, i.e. 498 cases, 996 former smokers and 996 never smokers. Mean age was 63.4 years (64.9% male). Smokers had higher glycosylated hemoglobin levels (7.4 vs. 7.2 and 7.2%, respectively; p=0.013) and a lower degree of metabolic control (49.2 vs. 54.7 and 55.8%; p=0.036). Smokers had higher average annual costs (EUR 3,583) than former smokers (EUR 2,885; p<0.001) and never smokers (EUR 2,183; p<0.001). CONCLUSIONS Diabetic smoker patients had lower metabolic control, higher health resource utilization and more sick leave, resulting in higher healthcare costs and lost productivity compared with both former and never smoker diabetics.
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