Cost-effectiveness of five different smoking cessation medication treatments Melissa Natzke Doctor of Pharmacy Candidate Master of Public Health Candidate

Acknowledgements Megan Piper, PhD Doug Jorenby, PhD Michael Fiore, MD, MPH Dave Kreling, RPh, MS, PhD John Mullahy, PhD Paul Fishman, PhD

Introduction Cigarette smoking is the leading preventable cause of morbidity and mortality in the world From 2001-2004, medical costs plus lost productivity attributable to smoking in the US totaled ~$193 billion dollars per year In comparison, in 2002 less than $900 million dollars were spent on state-level tobacco control programs

Introduction Tobacco cessation treatment is an extremely cost-effective use of health care dollars There are seven effective, FDA-approved tobacco cessation pharmacotherapies recommended by the 2008 Public Health Service Guideline Although combination pharmacotherapy may be particularly effective for tobacco cessation, cost effectiveness data is limited and is needed to help in selecting treatments

Objective Examine the relative cost-effectiveness of three single pharmacotherapies and two combination pharmacotherapies using placebo-controlled, head-to-head efficacy data from a single study

Demographics (n=1504) 58.2% female 83.9% self-identified Caucasian 13.6% self-identified African American Average age: 44.7 (SD 11.1) Cigarettes/day: 21.4 (SD 8.9) 23.5% <$25,000 annual household income 42.9% >$50,000 annual household income 23.6% had a high school education only 21.9% reported a 4-year college degree Add education level??

Interventions All conditions received six, brief, individual counseling sessions Six experimental conditions: Placebo (n = 189) Nicotine lozenge (n = 260) Nicotine patch (n = 262) Bupropion SR (n = 264) Nicotine patch plus nicotine lozenge (n = 267) Bupropion SR plus nicotine lozenge (n = 262)

Methods Two distinct perspectives: Cash-paying patient Third-party payer Cash prices an average from Walgreens and CVS pharmacies Third-party reimbursement 60% AWP from 2008 Red Book Efficacy determined by subtracting placebo efficacy from total efficacy at 8 weeks (end of treatment) and 6 months

Methods Calculated drug quantities at 8 weeks and 6 months Bupropion and patch – total expected usage Lozenge – median usage calculated from directions; multiplied by 2/3 for actual prn usage Cost effectiveness = (cost per 100 patients) (# quit per 100 patients)

Incremental Efficacy

Cost per Quit – Cash Paying

Cost per Quit – Third-Party Payer

Discussion The combination of the patch plus lozenge produced the highest incremental 6-month abstinence rates (17.9%) Monotherapy with either bupropion SR (third-party) or the nicotine patch (cash-paying) is the most cost-effective approach to achieve tobacco cessation Cost-effectiveness should not be the sole basis for choosing a tobacco cessation treatment All therapies are cost-effective compared with continuing to use tobacco

Conclusion These results add further support to the notion that tobacco cessation treatment is highly cost effective No matter what treatment is used, the most important thing smokers can do for their health is quit smoking