Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-19T01:22:59.871Z Has data issue: false hasContentIssue false
  • English
  • Français

Modelling a budgetary impact analysis for funding drug-based smoking cessation therapies for patients with major depressive disorder in Spain

Published online by Cambridge University Press:  23 March 2020

J. Rejas-Gutiérrez ,
E. Bruguera  and
S. Cedillo
J. Rejas-Gutiérrez*
Affiliation:
Health Economics and Outcomes Research Department, Pfizer, S.L.U., Alcobendas (Madrid), Spain
E. Bruguera
Affiliation:
Addictive Behaviour Unit of Psychiatry, Vall d’Hebron University Hospital, Barcelona, Spain
S. Cedillo
Affiliation:
Trial Form Support Develop, Madrid, Spain
*
*Corresponding author. Departamento de Farmacoeconomía e Investigación de Resultados en Salud, Pfizer, S.L.U., Avda. de Europa, 20-B, 28108 Alcobendas, Madrid. Fax: +91 490 9957. E-mail address:javier.rejas@pfizer.com (J. Rejas-Gutiérrez).
Get access

Abstract

Background:

Smoking is associated with high healthcare resource utilisation and cost to society. Patients with major depressive disorder (MDD) exhibit high susceptibility to nicotine dependence. Varenicline, bupropion and nicotine replacement therapy are all indicated for smoking cessation; however funding by the Spanish national health system (SNHS) is limited. We modelled a budgetary impact analysis (BIA) to estimate the impact of the SNHS funding drug-based therapies for smoking cessation in smokers with MDD.

Methods:

The BIA compared the current unfunded scenario versus a funded scenario (varenicline, bupropion, nicotine replacement therapy combined with medical follow-up and counselling) using the Spanish SNHS and societal perspectives. The BIA design was a hybrid model using a decision tree algorithm (population size: smokers with MDD) and Markov chains (smoking cessation attempts) over a 5-year horizon. Smoking cessation drug efficacy was derived from clinical trials, and smoking cessation costs avoided were taken from an analysis of the Spanish National Health Survey. Results were shown as incremental cost savings. Scenarios and threshold univariate sensitivity analyses tested model robustness.

Results:

The funded scenario resulted in an increase of 43,478 cessation attempts and 8930 fewer smokers after 5 years compared to the unfunded scenario. The cost of funding was €25.3 million and costs avoided were €26.5 million. There was a cumulative 5-year incremental cost saving of €1.2 million to Spanish society. Results were robust using alternative scenarios.

Conclusions:

Funding smoking cessation drugs in patients with MDD is of economic benefit to Spain and could produce net savings from the third year of implementation.

Keywords

Spanish national health systemMajor depressive disorderSmoking cessationBudget impact analysis
Type
Original article
Information
European Psychiatry , Volume 45 , September 2017 , pp. 41 - 49
Copyright
Copyright © European Psychiatric Association 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

World Health Organisation WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco; 2011.Google Scholar
Eriksen, MMackay, JSchluger, NGomeshtapeh, FIDrope, JThe Tobacco Atlas, 5th ed., American Cancer Society Inc.; 2015.Google Scholar
Gutiérrez-Abejón, ERejas-Gutiérrez, JCriado-Espegel, PCampo-Ortega, EPBreñas-Villalón, MTMartín-Sobrino, N[Smoking impact on mortality in Spain in 2012]. Med Clin 2015;145:520–525. http://dx.doi.org/10.1016/j.medcli.2015.03.013.CrossRefGoogle Scholar
Suárez-Bonel, MPVillaverde-Royo, MVNerín, ISanz-Andrés, CMezquida-Arno, JCórdoba-García, RHealth care costs and work absenteeism in smokers: study in an urban community. Arch Bronconeumol 2015;51:615–620. http://dx.doi.org/10.1016/j.arbres.2015.05.001.CrossRefGoogle Scholar
González-Enríquez, JSalvador-Llivina, TLópez-Nicolás, AAntón De Las Heras, EMusin, AFernández, E, et al.[The effects of implementing a smoking cessation intervention in Spain on morbidity, mortality and health care costs]. Gac Sanit SESPAS 2002;16:308–317.CrossRefGoogle Scholar
Rennard, SIDaughton, DMSmoking cessation. Clin Chest Med 2014;35:165–176. http://dx.doi.org/10.1016/j.ccm.2013.11.002.CrossRefGoogle ScholarPubMed
Jiménez-Ruiz, CARiesco Miranda, JARamos Pinedo, ABarrueco Ferrero, MSolano Reina, SDe Granda Orive, JI, et al.[Recommendations for pharmacological tobacco cessation treatments: proposals for financing]. Arch Bronconeumol 2008;44:213–219.CrossRefGoogle Scholar
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health The health consequences of smoking – 50 years of progress: a report of the surgeon general Atlanta (GA): Centers for Disease Control and Prevention (US); 2014Google Scholar
Breslau, NKilbey, MMAndreski, PNicotine dependence and major depression. New evidence from a prospective investigation. Arch Gen Psychiatry 1993;50:31–35.CrossRefGoogle ScholarPubMed
Lembke, AJohnson, KDeBattista, CDepression and smoking cessation: does the evidence support psychiatric practice?. Neuropsychiatr Dis Treat 2007;3:487–493.Google ScholarPubMed
Taylor, GMcNeill, AGirling, AFarley, ALindson-Hawley, NAveyard, PChange in mental health after smoking cessation: systematic review and meta-analysis. BMJ 2014;348:g1151. http://dx.doi.org/10.1136/bmj.g1151.CrossRefGoogle ScholarPubMed
Camarelles Guillem, FDalmau González-Gallarza, RClemente Jiménez, LDíaz-Maroto Muñoz, JLLozano Polo, A, Pinet Ogué M.C. grupo colaborador Comité Nacional para la Prevención del Tabaquismo (CNPT). Consensus report for the clinical care of smoking cessation in Spain. Comité Nacional para la Prevención del Tabaquismo. Med Clin 2013;140:272e1–272e12.Google ScholarPubMed
Fiore, MCJaén, CRBaker, TB, et al.Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockv, MD, US: Dep Health Hum Serv Public Health Serv; 2008.Google Scholar
Ebbert, JOWyatt, KDHays, JTKlee, EWHurt, RDVarenicline for smoking cessation: efficacy, safety, and treatment recommendations. Patient Prefer Adherence 2010;4:355–362.CrossRefGoogle ScholarPubMed
Cahill, KStevens, SPerera, RLancaster, TPharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013;CD009329. http://dx.doi.org/10.1002/14651858.CD009329.pub2.CrossRefGoogle Scholar
Anthenelli, RMMorris, CRamey, TSDubrava, SJTsilkos, KRuss, C, et al.Effects of varenicline on smoking cessation in adults with stably treated current or past major depression: a randomized trial. Ann Intern Med 2013;159:390–400. http://dx.doi.org/10.7326/0003-4819-159-6-201309170-00005.CrossRefGoogle ScholarPubMed
Brown, RANiaura, RLloyd-Richardson, EEStrong, DRKahler, CWAbrantes, AM, et al.Bupropion and cognitive-behavioral treatment for depression in smoking cessation. Nicotine Tob Res 2007;9:721–730. http://dx.doi.org/10.1080/14622200701416955.CrossRefGoogle ScholarPubMed
Kinnunen, TKorhonen, TGarvey, AJRole of nicotine gum and pretreatment depressive symptoms in smoking cessation: twelve-month results of a randomized placebo controlled trial. Int J Psychiatry Med 2008;38:373–389.CrossRefGoogle ScholarPubMed
Antoñanzas, FPortillo, F[Economic evaluation of pharmacotherapies for smoking cessation]. Gac Sanit SESPAS 2003;17:393–403.CrossRefGoogle Scholar
Fernández de Bobadilla Osorio, JSánchez-Maestre, CBrosa Riestra, MArroyo, OSanz de Burgoa, VWilson, K[Cost effectiveness analysis of varenicline (Champix) for the treatment of smoking in Spain]. An Med Int 2008;1984(25):342–348.Google Scholar
Sicras-Mainar, ADíaz-Cerezo, Sde Burgoa, VSNavarro-Artieda, RCost and clinical consequences of smoking cessation in outpatients after cardiovascular disease: a retrospective cohort study. Clin Outcomes Res 2013;5:419–427. http://dx.doi.org/10.2147/CEOR.S43256.CrossRefGoogle Scholar
Sicras-Mainar, ARejas-Gutiérrez, JNavarro-Artieda, RIbáñez-Nolla, JThe effect of quitting smoking on costs and healthcare utilization in patients with chronic obstructive pulmonary disease: a comparison of current smokers versus ex-smokers in routine clinical practice. Lung 2014;192:505–518. http://dx.doi.org/10.1007/s00408-014-9592-7.CrossRefGoogle ScholarPubMed
Sicras-Mainar, ARejas-Gutiérrez, JNavarro-Artieda, RIbánez-Nolla, JEffect of smoking status on healthcare costs and resource utilization in patients with type 2 diabetes in routine clinical practice: a retrospective nested case-control economic study. Eur Addict Res 2014;20:94–104. http://dx.doi.org/10.1159/000355171.CrossRefGoogle ScholarPubMed
Jiménez-Ruiz, CASolano-Reina, SSignes-Costa, Jde Higes-Martinez, EGranda-Orive, JILorza-Blasco, JJ, et al.Budgetary impact analysis on funding smoking-cessation drugs in patients with COPD in Spain. Int J Chron Obstruct Pulmon Dis 2015;10:2027–2036. http://dx.doi.org/10.2147/COPD.S87597.Google Scholar
Lock, KWilson, KMurphy, DRiesco, JAA cost-effectiveness model of smoking cessation based on a randomised controlled trial of varenicline versus placebo in patients with chronic obstructive pulmonary disease. Expert Opin Pharmacother 2011;12:2613–2626. http://dx.doi.org/10.1517/14656566.2011.628935.CrossRefGoogle ScholarPubMed
Wilson, KHettle, RMarbaix, SDiaz Cerezo, SInes, MSantoni, L, et al.An economic evaluation based on a randomized placebo-controlled trial of varenicline in smokers with cardiovascular disease: results for Belgium, Spain, Portugal, and Italy. Eur J Prev Cardiol 2012;19:1173–1183. http://dx.doi.org/10.1177/1741826711420345.CrossRefGoogle ScholarPubMed
Cedillo, SRejas, JEffect of smoking status on costs-of-illness in patients with a depressive disorder in spain: an approximation from the National Health Survey. Value Health 2016;19:A523. http://dx.doi.org/10.1016/j.jval.2016.09.1026.CrossRefGoogle Scholar
Sullivan, SDMauskopf, JAAugustovski, FJaime Caro, JLee, KMMinchin, M, et al.Budget impact analysis-principles of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value Health J 2014;17:5–14. http://dx.doi.org/10.1016/j.jval.2013.08.2291.CrossRefGoogle ScholarPubMed
Zhu, S.-H.Anderson, CMTedeschi, GJRosbrook, BJohnson, CEByrd, M, et al.Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med 2002;347:1087–1093. http://dx.doi.org/10.1056/NEJMsa020660.CrossRefGoogle ScholarPubMed
Ramon, JMNerin, IComino, APinet, CAbella, FCarreras, JM, et al.A multicentre randomized trial of combined individual and telephone counselling for smoking cessation. Prev Med 2013;57:183–188. http://dx.doi.org/10.1016/j.ypmed.2013.05.014.CrossRefGoogle ScholarPubMed
Guideline for smoking cessation of the Catalonia Institute of Health [Guía de deshabituación tabáquica del Instituto Catalán de la Salud]; 2016 [Accessed October 18, 2016]. Available from: http://www.ics.gencat.cat/3clics/main.php?page=GuiaPage&idGuia=1&lang=CAS.Google Scholar
Instituto Nacional de Estadística Censo poblacional de 2015. Población residente por fecha, sexo y edad; 2016 Available at: http://www.ine.es/jaxiT3/Tabla.htm?t=9663&L=0 (Accessed May 2016).Google Scholar
Fernández, AHaro, JMCodony, MVilagut, GMartínez-Alonso, MAutonell, J, et al.Treatment adequacy of anxiety and depressive disorders: primary versus specialised care in Spain. J Affect Disord 2006;96:9–20. http://dx.doi.org/10.1016/j.jad.2006.05.005.CrossRefGoogle Scholar
Gabilondo, ARojas-Farreras, SVilagut, GHaro, JMFernández, APinto-Meza, A, et al.Epidemiology of major depressive episode in a southern European country: results from the ESEMeD-Spain project. J Affect Disord 2010;120:76–85. http://dx.doi.org/10.1016/j.jad.2009.04.016.CrossRefGoogle Scholar
Ministerio de Sanidad, Servicios Sociale s e Igualdad – Portal Estadístico del SNS – Sistema de Información Sanitaria: Portal Estadístico del SNS – Encuesta Nacional n.d. http://www.msssi.gob.es/estadEstudios/estadisticas/encuestaNacional/encuesta2011.htm. (accessed September 28, 2016).Google Scholar
Getsios, DMarton, JPRevankar, NWard, AJWillke, RJRublee, D, et al.Smoking cessation treatment and outcomes patterns simulation: a new framework for evaluating the potential health and economic impact of smoking cessation interventions. PharmacoEconomics 2013;31:767–780. http://dx.doi.org/10.1007/s40273-013-0070-5.CrossRefGoogle ScholarPubMed
Krall, EAGarvey, AJGarcia, RISmoking relapse after 2 years of abstinence: findings from the VA Normative Aging Study. Nicotine Tob Res 2002;4:95–100. http://dx.doi.org/10.1080/14622200110098428.CrossRefGoogle ScholarPubMed
Royal Decree-Law (RD) Real Decreto-ley 8/2010, de 20 de mayo, por el que se adoptan medidas extraordinarias para la reducción del déficit público. Vol. 126. BOE [Spain's Official Government Gazette] de 24 de Mayo; 2010. [Accessed October 18, 2016]. p. 2010. Available from: www.boe.es/boe/dias/2010/05/24/pdfs/BOE-A-2010-8228.pdf. n.d.Google Scholar
eSalud, Gisbert, RBrosa, MBase de Datos de Costes Sanitarios eSalud. [Internet]. Barcelona; 2013 Available at http://www.oblikue.com. [Accessed October 18, 2016].Google Scholar
Wetter, DWCofta-Gunn, LFouladi, RTCinciripini, PMSui, DGritz, ERLate relapse/sustained abstinence among former smokers: a longitudinal study. Prev Med 2004;39:1156–1163. http://dx.doi.org/10.1016/j.ypmed.2004.04.028.CrossRefGoogle Scholar
López-Bastida, JOliva, JAntoñanzas, FGarcía-Altés, AGisbert, RMar, J, et al.Spanish recommendations on economic evaluation of health technologies. Eur J Health Econ 2010;11:513–520. http://dx.doi.org/10.1007/s10198-010-0244-4.CrossRefGoogle ScholarPubMed
Anthenelli, RMBenowitz, NLWest, RSt Aubin, LMcRae, TLawrence, D, et al.Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet 2016;387:2507–2520. http://dx.doi.org/10.1016/S0140-6736(16)30272-0.CrossRefGoogle ScholarPubMed
Song, FRaftery, JAveyard, PHyde, CBarton, PWoolacott, NCost-effectiveness of pharmacological interventions for smoking cessation: a literature review and a decision analytic analysis. Med Decis Mak Int 2002;22:S26–S37.CrossRefGoogle Scholar
Woolacott, NFJones, LForbes, CAMather, LCSowden, AJSong, FJ, et al.The clinical effectiveness and cost-effectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation. Health Technol Assess 2002;6:1–245.CrossRefGoogle ScholarPubMed
Cornuz, JGilbert, APinget, CMcDonald, PSlama, KSalto, E, et al.Cost-effectiveness of pharmacotherapies for nicotine dependence in primary care settings: a multinational comparison. Tob Control 2006;15:152–159. http://dx.doi.org/10.1136/tc.2005.011551.CrossRefGoogle ScholarPubMed
Taylor, DCAChu, PRosen, VMBaker, CLThompson, DBudgetary impact of varenicline in smoking cessation in the United Kingdom. Value Health J 2009;12:28–33. http://dx.doi.org/10.1111/j.1524-4733.2008.00395.x.CrossRefGoogle Scholar
Atsou, KChouaid, CHejblum, GSimulation-based estimates of effectiveness and cost-effectiveness of smoking cessation in patients with chronic obstructive pulmonary disease. Plos One 2011;6:e24870. http://dx.doi.org/10.1371/journal.pone.0024870.CrossRefGoogle ScholarPubMed
Cedillo, SSicras-Mainar, AJiménez-Ruiz, CAFernández de Bobadilla, JRejas-Gutiérrez, JBudgetary impact analysis of reimbursement varenicline for the smoking-cessation treatment in patients with cardiovascular diseases, chronic obstructive pulmonary disease or type-2 diabetes mellitus: a national health system perspective. Eur Addict Res 2016;23:7–18. http://dx.doi.org/10.1159/000449098.CrossRefGoogle ScholarPubMed
Rasmussen, SRPrescott, ESørensen, TIASøgaard, JThe total lifetime health cost savings of smoking cessation to society. Eur J Public Health 2005;15:601–606. http://dx.doi.org/10.1093/eurpub/cki024.CrossRefGoogle Scholar
Kehoe, RWu, SYLeske, MCChylack, LTComparing self-reported and physician-reported medical history. Am J Epidemiol 1994;139:813–818.CrossRefGoogle ScholarPubMed
Kriegsman, DMPenninx, BWvan Eijk, JTBoeke, AJDeeg, DJSelf-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients’ self-reports and on determinants of inaccuracy. J Clin Epidemiol 1996;49:1407–1417.CrossRefGoogle Scholar
Agaku, ITKing, BADube, SRCenters for Disease Control and Prevention (CDC). Current cigarette smoking among adults – United States, 2005–2012. MMWR Morb Mortal Wkly Rep 2014;63:29–34.Google ScholarPubMed
Lasser, KBoyd, JWWoolhandler, SHimmelstein, DUMcCormick, DBor, DHSmoking and mental illness: a population-based prevalence study. JAMA 2000;284:2606–2610.CrossRefGoogle ScholarPubMed
Gierisch, JMBastian, LACalhoun, PSMcDuffie, JRWilliams, JWComparative effectiveness of smoking cessation treatments for patients with depression: a systematic review and meta-analysis of the evidence Washington (DC): Department of Veterans Affairs; 2010Google Scholar
Sicras-Mainar, AGuijarro, PArmada, BBlanca-Tamayo, MNavarro-Artieda, RInfluence of the CYP2D6 isoenzyme in patients treated with venlafaxine for major depressive disorder: clinical and economic consequences. PloS One 2014;9:e90453. http://dx.doi.org/10.1371/journal.pone.0090453.CrossRefGoogle ScholarPubMed
Sicras-Mainar, ANavarro-Artieda, RUse of antidepressants in the treatment of major depressive disorder in primary care during a period of economic crisis. Neuropsychiatr Dis Treat 2016;12:29–40. http://dx.doi.org/10.2147/NDT.S91227.Google ScholarPubMed
Francisco, JCallejas, GGenovés Crespo, MCruz Ruiz, JEsquinas López, CTárraga López Pedro, J, et al.A comparative study for successful treatment per gender in a specialized smoking cessation unit in the Albacete University Hospital during two years. J Health Sci 2015;3. http://dx.doi.org/10.17265/2328-7136/2015.03.001.CrossRefGoogle Scholar
Consejo General de Colegios Oficiales de Farmacéuticos de España Bot PLUS web 2015 drug catalogue; 2015, http://www.portalfarma.com/Paginas/default.aspx (accessed September 28, 2016).Google Scholar
Submit a response

Comments

No Comments have been published for this article.