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

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

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Citation

Please use this url to cite or link to this publication:

Chicago
Wilson, Koo, Robert Hettle, Sophie Marbaix, Silvia Diaz Cerezo, Monica Ines, Laura Santoni, Lieven Annemans, Jacques Prignot, and Esteban Lopez de Sa. 2012. “An Economic Evaluation Based on a Randomized Placebo-controlled Trial of Varenicline in Smokers with Cardiovascular Disease: Results for Belgium, Spain, Portugal, and Italy.” European Journal of Preventive Cardiology 19 (5): 1173–1183.
APA
Wilson, K., Hettle, R., Marbaix, S., Diaz Cerezo, S., Ines, M., Santoni, L., Annemans, L., et al. (2012). An economic evaluation based on a randomized placebo-controlled trial of varenicline in smokers with cardiovascular disease: results for Belgium, Spain, Portugal, and Italy. EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, 19(5), 1173–1183.
Vancouver
1.
Wilson K, Hettle R, Marbaix S, Diaz Cerezo S, Ines M, Santoni L, et al. An economic evaluation based on a randomized placebo-controlled trial of varenicline in smokers with cardiovascular disease: results for Belgium, Spain, Portugal, and Italy. EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY. 2012;19(5):1173–83.
MLA
Wilson, Koo, Robert Hettle, Sophie Marbaix, et al. “An Economic Evaluation Based on a Randomized Placebo-controlled Trial of Varenicline in Smokers with Cardiovascular Disease: Results for Belgium, Spain, Portugal, and Italy.” EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY 19.5 (2012): 1173–1183. Print.
@article{3061095,
  abstract     = {Background: An estimated 17.2\% of patients continue to smoke following diagnosis of cardiovascular disease (CVD). To reduce the risk of further morbidity or mortality in cardiovascular patients, smoking cessation has been shown to reduce the risk of mortality by 36\% and myocardial infarction by 32\%. The objective of this study was to evaluate the long-term health and economic consequences of smoking cessation in patients with CVD. 
Design and methods: Results of a randomized clinical trial comparing varenicline plus counselling vs. placebo plus counselling were extrapolated using a Markov model to simulate the lifetime costs and health consequences of smoking cessation in patients with stable CVD. For the base case, we considered a payer's perspective including direct costs attributed to the healthcare provider, measuring cumulative life years (LY) and quality adjusted life (QALY) years as outcome measures. Secondary analyses were conducted from a societal perspective, evaluating lost productivity due to premature mortality. Sensitivity and subgroup analyses were also undertaken. Results were analysed for Belgium, Spain, Portugal, and Italy. 
Results: Varenicline plus counselling was associated with a gain in LY and QALY across all countries; relative to placebo plus counselling. From a payer's perspective, incremental cost effectiveness ratios were (sic)6120 (Belgium), (sic)5151 (Spain), (sic)5357 (Portugal), and (sic)5433 (Italy) per QALY gained. From a societal perspective, varenicline in addition to counselling was less costly than placebo and counselling in all cases. Sensitivity analyses showed little sensitivity in outcomes to model assumptions or uncertainty in model parameters. 
Conclusions: Varenicline in addition to counselling is cost-effective compared to placebo and counselling in smokers with CVD.},
  author       = {Wilson, Koo and Hettle, Robert and Marbaix, Sophie and Diaz Cerezo, Silvia and Ines, Monica and Santoni, Laura and Annemans, Lieven and Prignot, Jacques and Lopez de Sa, Esteban},
  issn         = {2047-4873},
  journal      = {EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY},
  keyword      = {economic,HEALTH,smoking cessation,cost-effectiveness,Cardiovascular disease,varenicline,CORONARY-HEART-DISEASE,OBSTRUCTIVE PULMONARY-DISEASE,QUALITY-OF-LIFE,COST-EFFECTIVENESS,SMOKING-CESSATION,EUROPEAN COUNTRIES,UNITED-STATES,RISK-FACTORS,FOLLOW-UP},
  language     = {eng},
  number       = {5},
  pages        = {1173--1183},
  title        = {An economic evaluation based on a randomized placebo-controlled trial of varenicline in smokers with cardiovascular disease: results for Belgium, Spain, Portugal, and Italy},
  url          = {http://dx.doi.org/10.1177/1741826711420345},
  volume       = {19},
  year         = {2012},
}

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