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Cost‐effectiveness analysis of clinical smoking cessation interventions in Thailand
Author(s) -
Tosanguan Jiraboon,
Chaiyakunapruk Nathorn
Publication year - 2016
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.13166
Subject(s) - varenicline , quitline , medicine , smoking cessation , psychological intervention , nicotine replacement therapy , cost effectiveness , bupropion , nicotine patch , psychiatry , alternative medicine , risk analysis (engineering) , pathology , placebo
Aims Clinical smoking cessation interventions have been found typically to be highly cost‐effective in many high‐income countries. There is a need to extend this to low‐ and middle‐income countries and undertake comparative analyses. This study aimed to estimate the incremental cost‐effectiveness ratio of a range of clinical smoking cessation interventions available in Thailand. Methods Using a Markov model, cost‐effectiveness, in terms of cost per quality‐adjusted life years (QALY) gained, from a range of interventions was estimated from a societal perspective for males and females aged 40 years who smoke at least 10 cigarettes per day. Interventions considered were: counselling in hospital, phone counselling (Quitline) and counselling plus nicotine gum, nicotine patch, bupropion, nortriptyline or varenicline. An annual discounting rate of 3% was used. Probabilistic sensitivity analyses were conducted and a cost‐effectiveness acceptability curve (CEAC) plotted. Comparisons between interventions were conducted involving application of a ‘decision rule’ process. Results Counselling with varenicline and counselling with nortriptyline were found to be cost‐effective. Hospital counselling only, nicotine patch and bupropion were dominated by Quitline, nortriptyline and varenicline, respectively, according to the decision rule. When compared with unassisted cessation, probabilistic sensitivity analysis revealed that all interventions have very high probabilities (95%) of being cost‐saving except for nicotine replacement therapy (NRT) patch (74%). Conclusion In middle‐income countries such as Thailand, nortriptyline and varenicline appear to provide cost‐effective clinical options for supporting smokers to quit.