1. ¹Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
2. ²The Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
3. ³Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center, Philadelphia, PA, USA
4. ⁴The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
5. ⁵The Transdisciplinary Tobacco Use Research Center, University of Pennsylvania, Philadelphia, PA, USA
6. ⁶Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
7. ⁷Department of Pharmacology, University of Pennsylvania, Philadelphia, PA, USA

Correspondence: Professor DF Heitjan, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 622 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. E-mail: dheitjan@mail.med.upenn.edu

Received 8 May 2007; Revised 12 December 2007; Accepted 20 December 2007; Published online 18 March 2008.

Abstract

We evaluated the cost-effectiveness of a range of smoking cessation drug treatments, including varenicline, transdermal nicotine (TN), bupropion and the use of a genetic test to choose between TN and bupropion. We performed Monte Carlo simulation with sensitivity analysis, informing analyses with published estimates of model parameters and current prices for genetic testing and smoking-cessation therapy. The primary outcomes were discounted life-years (LY) and lifetime tobacco-cessation treatment costs. In the base case, varenicline treatment was optimal with an ICER, compared to bupropion, of $2985/LY saved. In sensitivity analyses, varenicline was in all cases (and bupropion in most cases) admissible; only under favorable assumptions was the genetically tailored approach competitive. Our data suggest that an untailored approach of treatment with either bupropion or varenicline is a cost-effective form of tobacco dependence treatment, but a tailored approach for selecting between TN and bupropion can be cost-effective under plausible assumptions.