Healthcare Costs of Smokers Using Varenicline Versus Nicotine-Replacement Therapy Patch in the United States: Evidence from Real-World Practice

Abstract

Introduction: Varenicline (VAR) is an effective smoking-cessation therapy compared to the commonly used nicotine-replacement therapy patch (NRT-P). However, comparative real-world evidence on smoking-cessation therapies is limited, especially for economic outcomes.

Methods: Using national claims databases (2012-2016) in the United States (US), adults initiating VAR or NRT-P without use of any other smoking-cessation products were followed for up to 1 year on a quarterly basis. Outcomes included smoking-attributable (SA) (cardiovascular, diabetes, pulmonary diseases, and smoking cessation) and all-cause costs (2017 US dollars). Adjusted mean costs were estimated from multivariable regressions, with baseline characteristics and propensity scores as covariates. Annual adjusted costs were calculated from quarterly averages.

Results: The VAR cohort (n = 209,284) was younger (mean age 46.7 vs. 49.0 years) and had fewer comorbidities [mean Charlson Comorbidity Index (CCI): 0.8 vs. 1.6] than the NRT-P cohort (n = 34,593). After adjustment, VAR cohort had lower SA and all-cause medical costs than NRT-P cohort in Quarters 1-4 (Q1-Q4) of follow-up, and had lower SA and all-cause total costs in Q2-Q4. Annually, VAR cohort had higher SA total costs ($307) and lower all-cause costs (- $2089) than NRT-P cohort. Annual medical costs were lower in VAR cohort (- $640 for SA and - $2876 for all-cause), and pharmacy costs were higher ($762 for SA and $777 for all-cause). In adherent patients (VAR: n = 38,744; NRT-P: n = 2702), VAR patients had lower annual medical costs (- $794 for SA and - $1636 for all-cause) and higher pharmacy costs ($1175 for SA and $1269 for all-cause); differences in SA and all-cause total costs were not statistically significant between treatment groups.

Conclusions: Lower SA and all-cause medical costs associated with the use of VAR versus NRT-P resulted in savings in all-cause total costs and, among adherent patients, potentially offset the high pharmacy costs of VAR.

Funding: Pfizer, Inc.

Keywords: Healthcare costs; Real-world evidence; Varenicline.

Fig. 1

Study periods

Fig. 2

Sample selection of patients in initiator and adherent populations. NRT nicotine-replacement therapy, RX prescription, MPR medication possession ratio, VAR varenicline

Fig. 3

Adjusted cost differences (varenicline vs. NRT patch) by quarter. Adjusted differences between the VAR and NRT patch cohorts and the 95% CI are presented; adjusted costs in each quarter were estimated from multivariable regression models, adjusting for the following baseline characteristics—demographics, CCI, diagnosis of specific conditions [cardiovascular diseases, diabetes mellitus, pulmonary conditions, neuropsychiatric conditions, malignancy (excluding skin cancer), and tobacco dependence], use of smoking-cessation counseling, occurrence of hospitalization (SA or all cause, corresponding to study outcomes), healthcare costs (corresponding to study outcomes)—and propensity scores. RX pharmacy, SA smoking-attributable, VAR varenicline

Fig. 4

Adjusted annual costs. *P value < 0.05; difference between cohorts may not be exact due to rounding; adjusted annual costs, estimated as four times the quarterly average of adjusted costs per patient, showed the average costs would incur if the patients had 1 year of follow-up; adjusted costs in each quarter were estimated from multivariable regression models, adjusting for the following baseline characteristics—demographics, CCI, diagnosis of specific conditions [cardiovascular diseases, diabetes mellitus, pulmonary conditions, neuropsychiatric conditions, malignancy (excluding skin cancer), and tobacco dependence], use of smoking-cessation counseling, occurrence of hospitalization (SA or all cause, corresponding to study outcomes), healthcare costs (corresponding to study outcomes)—and propensity scores. ER emergency room, NRT nicotine replacement therapy, RX pharmacy, SA smoking-attributable, VAR varenicline