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Smoking cessation programs for Crohn's improve outcomes, reduce costs
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The integration of smoking cessation programs targeting patients with Crohn’s disease is cost-effective for health care systems, recent study data found.
“Smoking is known to worsen the course of Crohn’s disease, whereas individuals who quit have a similar prognosis to patients with Crohn’s disease who never smoked,” Stephanie Coward, MSc, and Gilaad G. Kaplan, MD, MPH, both from the University of Calgary in Alberta, Canada, told Healio Gastroenterology. “We conducted a cost-utility analysis to compare different smoking cessation strategies for patients with Crohn’s disease.”
Stephanie Coward
Gilaad G. Kaplan
To evaluate the cost-effectiveness of smoking cessation programs for patients with Crohn’s disease, Coward, Kaplan and colleagues used a 5-year Markov model, and the patient population included smokers newly diagnosed with Crohn’s disease aged 18 to 35 years who were anti-tumor necrosis factor-naive.
Health states included medical remission (azathioprine or anti-TNF), dose escalation of anti-TNF, second anti-TNF, surgery and death. The researchers derived probabilities for patient outcomes from peer-reviewed literature, and they locally estimated costs for surgery, medications and smoking cessation programs. The primary outcome was the cost per quality-adjusted life-year (QALY) gained with each program. A threshold analysis was performed to determine effectiveness required for superiority of each program, a three-way sensitivity analysis was performed for the costs of each program, probabilistic sensitivity analyses were performed to account for variation in each program’s effectiveness and budget impact analyses were performed using Canadian and U.S. cost and population data.
All smoking cessation programs were superior to not implementing a program, and ranked in terms of cost-effectiveness as follows:
- Chantix (varenicline, Pfizer)
- 5-year cost: $55,614 (95% CI, 52,755-58,474)
- QALY: 3.7 (95% CI, 3.68-3.73)
- Nicotine replacement therapy plus counseling
- 5-year cost: $58,878 (95% CI, 56,050-61,706)
- QALY: 3.69 (95% CI, 3.66-3.72)
- Nicotine replacement therapy
- 5-year cost: $59,540 (95% CI, 56,732-62,347)
- QALY: 3.69 (95% CI, 3.66-3.71)
- Counseling
- 5-year cost: $61,029 (95% CI, 58,246-63,812)
- QALY: 3.68 (95% CI, 3.65-3.71)
- No program
- 5-year cost: $63,601 (95% CI, 60,865-66,337)
- QALY: 3.67 (95% CI, 3.64-3.69)
Not implementing a program was the least cost-effective strategy nearly 100% of the time and was only more cost-effective when every strategy’s cost exceeded its estimated costs about 10-fold. Budget impact analyses showed that not implementing a program costs the Canadian health care system $128.3 million over 5 years, whereas the varenicline strategy saves it more than $16.1 million, and cost-savings for varenicline was more than $61 million in the United States.
“Funding any smoking cessation program was a more cost-effective option than continuing with the status quo; though, treatment with varenicline was associated with the most cost-savings,” Coward and Kaplan said. “Health care providers and administrators can use this information to integrate smoking cessation programs targeted for patients with Crohn’s disease.” – by Adam Leitenberger
Disclosure: Coward reports no relevant financial disclosures. Kaplan reports various financial ties with Abbott, Jansen, Merck, Schering-Plough, Shire and UCB Pharma. Please see the study for a full list of all other authors’ relevant financial disclosures.
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