Cost-effectiveness of Varenicline versus existing alternatives for smoking cessation using the BENESCO model in the costarican adult population

Aim:  Tobacco use is one of the most serious health problems worldwide and it´s a preventable addiction; this is why the availability of treatments to quit smoking represents a great benefit to each individual’s health as to institutional systems. Given the use of new treatments, particularly Varenicline, the available choices in Costa Rica must be comparatively evaluated because it is not clear which therapeutic option is the best and which generates the best cost-effectiveness ratio. The aim of this study was to model the cost-effectiveness of the therapeutic options for smoking cessation available in Costa Rica using the BENESCO model. Methods: The BENESCO model was used to simulate the morbidity and mortality of the smoking population of Costa Rica, for both genders, between 18 and 99 years old. In this model, each smoker makes only one attempt to quit smoking at the beginning of the simulation. The strategies compared were: Varenicline, Bupropion, Nicotine replacement therapy, self determination (without intervention) and motivational group-speeches. The smoking-related diseases taken into account were: acute myocardial infarction, chronic obstructive pulmonary disease, stroke and lung cancer. The prevalence, incidence and mortality were obtained and calculated from the Costarican Social Security´s (CCSS) data base and the Institute of Alcoholism and Pharmacodependence of Costa Rica (IAFA). The costs of the diseases were calculated and updated to September, 2008.Deterministic, probabilistic and sensitivity analyses were carried out. Results: Of all the strategies for smoking cessation, Varenicline was the therapeutic alternative with the less mortality and morbidity in the studied years. Regarding costs, Varenicline was also the less expensive option after the fifth year. After 2 years, motivational speeches were ¢3.443.167 cheaper than Varenicline. The intervention with the largest number of quality-adjusted life years and gained life years was Varenicline. Varenicline was the most effective option in the cost-incremental analysis, this means, it was clinically the most.Conclusion: The results obtained suggest that Varenicline is the best cost-effective intervention for smoking cessation in comparison with Bupropion, NRT, self determination and motivational speeches. It was proven that Varenicline represents important economic savings for health systems and health institutes using it, since it reduces morbidity and the costs related to tobacco-associated diseases.