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

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

3. Introduction
Cigarette smoking is the leading preventable cause of morbidity and mortality in the world
From , 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

4. 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

5. 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

6. 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??

7. 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)

8. 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

9. 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)

10. Incremental Efficacy

11. Cost per Quit – Cash Paying

12. Cost per Quit – Third-Party Payer

13. 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

14. 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