%0 Journal Article 
%A Trapero Bertrán, Marta
%A Muñoz, Celia
%A Coyle, Kathryn
%A Coyle, Doug
%A Lester George, Adam
%A Leidl, Reiner
%A Németh, Bertalan
%A Cheung, Kei-Long
%A Pokhrel, Subhash
%A López Nicolás, Ángel
%T Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD
%D 2018
%@ 1360-0443
%U http://hdl.handle.net/10317/7741
%X AIMS:
To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS).

DESIGN:
We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life-time costs and benefits.

SETTING:
Spain.

PARTICIPANTS:
Adult smoking population (16+ years).

MEASUREMENTS:
Health-care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates.

FINDINGS:
The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life-time benefit-cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generated more QALYs) from the life-time perspective, compared with the current provision. The life-time benefit-cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis.

CONCLUSIONS:
According to the EQUIPTMOD modelling tool it would be cost-effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro-active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run.
%K Economía Financiera y Contabilidad
%K Cost-effectiveness
%K EQUIPT
%K Smoking cessation interventions
%K Tobacco control
%K 3212 Salud Publica
%~ GOEDOC, SUB GOETTINGEN