Budgetary impact analysis on funding smoking-cessation drugs in patients with COPD in Spain

Abstract

The aim of the study was to assess the budgetary impact of funding smoking-cessation drugs in COPD patients in Spain. A hybrid model (cohort and Markov) was developed for a 5-year time horizon. Only approved cessation drugs (varenicline, bupropion, and nicotine replacement therapy) were considered. Irrespective of the drug, the model allowed for an initial cessation attempt, and up to three additional attempts in case of failure or smoking relapse during a 5-year period. Drug effectiveness was based on controlled clinical trials. National Health System perspective was applied; therefore, only medical resources were included. The pharmaceutical costs for smoking-cessation drugs, extra medical follow-up as a consequence of public reimbursement, and annual savings for health costs avoided due to stopping smoking were considered. The model estimated that 17,756 COPD patients would stop smoking if public funding was available, compared with 1,303 without reimbursement. In the reimbursement scenario, the savings accounted for a total of €48.0 million, compensating for expenditures on drugs and medical visits (€40.4 million). Accumulated total additional savings in 5 years (€4.3 million) compared with the scenario without reimbursement was shown. Sensitivity analyses supported the results robustness. Funding smoking-cessation drugs in COPD patients seems to be an efficient option and a National Health System drug reimbursement scheme would represent a cost-saving policy in Spain.

Keywords: COPD; budgetary impact; health service; pharmacotherapy; smoking cessation.

Figure 1

Diagram of the model: epidemiological cohort and Markov chain. Abbreviations: COPD, chronic obstructive pulmonary disease; NRT, nicotine replacement therapy.

Figure 2

Results of the budget impact for the sensitivity analysis. Notes: The values (in millions of €) of the different scenarios show the impact of the current funded scenario compared with the current unfunded scenario. BIA, budget-impact analysis. The values (in millions of €) of the different scenarios show the impact of this scenario on the current unfunded scenario after discarding the value observed in the current scenario. Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 3

Tornado chart showing the results of the accumulated budgetary impact after the 5-year sensitivity analysis. Note: The values (in millions of €) indicate the differences between the funded and unfunded scenarios. Abbreviation: COPD, chronic obstructive pulmonary disease.