Kosteneffektivität von pharmakologischen Raucherentwöhnungsmaßnahmen – ein systematisches Literaturreview

Zusammenfassung

Ziel der Studie: Tabakkonsum ist das bedeutsamste Gesundheitsrisiko weltweit. Folglich ist es notwendig, möglichst wirksame und kosteneffektive Entwöhnungsmaßnahmen bereitzustellen. In Deutschland werden die Kosten von pharmakologischen Raucherentwöhnungsmaßnahmen von den gesetzlichen Krankenkassen bisher nicht erstattet. Ziel dieser Studie ist es, die Evidenz zur Kosteneffektivität bereits zugelassener pharmakologischer Entwöhnungshilfen darzustellen und deren Qualität zu bewerten.

Methodik: Relevante Publikationen wurden durch eine systematische Literaturrecherche in 8 Datenbanken inklusive Medline und Embase im April 2013 (Update April 2014) über das Deutsche Institut für medizinische Dokumentation und Information identifiziert. Gesucht wurden alle Studien zur Kosteneffektivität der Nikotinersatztherapie (NET), Vareniclin und Bupropion. Die Bewertung der Studienqualität erfolgte mithilfe des „Quality of Health Economic Studies“ (QHES) Instruments.

Ergebnisse: Von 10 340 identifizierten Studien konnten 33 final eingeschlossen werden. Die Studien stellten einen Vergleich der Pharmakotherapien zur medizinischen Beratung als auch einen Vergleich der Pharmakotherapien untereinander her. Der Großteil der Studien zeigt, dass eine zusätzliche Verschreibung von NET oder Bupropion zu einer medizinischen Beratung eine kosteneffektive Strategie ist und eine Dominanz von Vareniclin gegenüber Bupropion vorliegt. Insgesamt zeigte sich eine heterogene Studienqualität zwischen 45 und 80 Punkten (Ø 63,7 von 100 Punkten).

Schlussfolgerung: Die Studien zeigen, dass die Behandlung mit Vareniclin die kosteneffektivste Entwöhnungshilfe gefolgt von Bupropion und der NET ist. Allerdings lassen sich die Studien aufgrund unterschiedlicher Ausprägungen des Alters, Geschlechts sowie landesspezifischer Kosten nur unzureichend vergleichen.

Abstract

Aim of the Study: Through the promotion of smoking cessation premature mortality can be prevented. Therefore it is necessary to provide effective and cost-effective smoking cessation interventions. In Germany the cost of pharmacological smoking cessation measures are not yet reimbursed by the statutory health insurance. The aim of this study is to present the evidence on the cost-effectiveness of already approved pharmacological smoking cessation therapies and to evaluate their quality.

Method: A systematic literature research was conducted in the databases by DIMDI (Medline, Embase, etc.) in April 2013 (update April 2014). The study research was focused on studies for cost effectiveness of nicotine replacement therapy (NRT), varenicline and bupropion. The assessment of study quality was performed using the "Quality of Health Economic Studies" (QHES) instrument.

Results: 33 Of the original 10 340 identified studies were finally included. The majority of the studies show that an additional prescription of NRT or bupropion to a medical consultation is a cost-effective strategy. In addition, in most studies varenicline is a dominant strategy compared to bupropion. Overall, the study quality was found to be very heterogeneous between 45 and 80 points (Ø 63.7 points).

Conclusion: The studies show that treatment with varenicline is the most cost effective strategy followed by bupropion and the NRT. However, the studies can only be compared inadequately due to different levels of age and country-specific intervention costs.

Schlüsselwörter

Kosteneffektivität - pharmakologische Raucherentwöhnungsmaßnahmen - Nikotin - Bupropion - Vareniclin

Key words

cost-effectiveness - pharmacological smoking cessation therapies - nicotine - bupropion - vareniclin

• Literatur

• 1 Batra A. Tabakabhängigkeit. Hamm: DHS; 2003
• 2 World Health Organization . The world health report 2003. Shaping the future. Geneva: WHO; 2003
• 3 Deutsche Hauptstelle für Suchtfragen e.V. Tabak: Basisinformationen. Im Internet: http://www.dhs.de/fileadmin/user_upload/pdf/Broschueren/Basisinfo_Tabak.pdf Stand: 15.01.2015
• 4 Wacker M, Holle R, Heinrich J et al. The association of smoking status with healthcare utilisation, productivity loss and resulting costs: results from the population-based KORA F4 study. BMC. Health Serv Res 2013; 13: 278-286
• 5 Destatis (Hrsg.). Harmonisierter Verbraucherpreisindex. Im Internet: https://www.destatis.de/DE/ZahlenFakten/GesamtwirtschaftUmwelt/Preise/AbweichungHVPI.html Stand: 01.02.2014
• 6 Ofman JJ, Sullivan SD, Neumann PJ et al. Examining the value and quality of health economic analyses: implications of utilizing the QHES. J Manag Care Pharm 2003; 9: 53-61
• 7 Wasem J, Jung M, May U et al. Nutzen und Kosteneffektivität der Nikotinersatztherapie zur Raucherentwöhnung - eineentscheidungsanalytische Modellierung der direkten medizinischen Kosten. Gesundh ökon Qual manag 2008; 13: 99-108
• 8 Tran MT, Holdford DA, Kennedy DT et al. Modeling the Cost-Effectiveness of a Smoking-Cessation Program in a Community Pharmacy Practice. Pharmacotherapy 2002; 22: 1623-1631
• 9 Bertram MY, Lim SS, Wallace AL et al. Costs and benefits of smoking cessation aids: making a case for public reimbursement of nicotine replacement therapy in Australia. Tob. Control 2007; 16: 255-260
• 10 Fiscella K, Franks P. Cost-effectiveness of the transdermal nicotine patch as an adjunct to physicians’ smoking cessation counseling. JAMA 1996; 275: 1247-1250
• 11 Fellows JL, Bush T, McAfee T et al. Cost effectiveness of the Oregon quitline "free patch initiative". Tob. Control 2007; 16: 47
• 12 Hollis JF, McAfee TA, Fellows JL et al. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tob. Control 2007; 16: 53
• 13 Stapleton JA, Lowin A, Russel MA. Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness. Lancet 1999; 354: 210-215
• 14 Wasley MA, McNagny SE, Phillips VL et al. The cost-effectiveness of the nicotine transdermal patch for smoking cessation. Prev Med 1997; 26: 264-270
• 15 Cromwell J, Bartosch WJ, Fiore MC et al. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. JAMA 1997; 278: 1759-1766
• 16 Gilbert AR, Pinget C, Bovet P et al. The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles. Tob. Control 2004; 13: 190-195
• 17 Feenstra TL, Hamberg-van Reenen HH, Hoogenveen R. Cost-Effectiveness of Face-to-Face Smoking Cessation Interventions: A Dynamic Modeling Study. Value Health 2005; 8: 178-190
• 18 Cornuz J, Gilbert A, Pinget C et al. Cost-effectiveness of pharmacotherapies for nicotine dependence in primary care settings: a multinational comparison. Tob. Control 2006; 15: 152-159
• 19 Rasch A, Greiner W. Gesundheitsökonomisches Modell der Raucherentwöhnung mit Vareniclin. Suchtmedizin in Forschung und Praxis 2009; 11: 47-55
• 20 Annemans L, Nackaerts K, Bartsch P et al Cost Effectiveness of Varenicline in Belgium, Compared with Bupropion, Nicotine Replacement Therapy, Brief Counselling and Unaided Smoking Cessation. Clin Drug Investig 2009; 29
• 21 Athanasakis K, Igoumenidis M, Karampli E et al Cost-Effectiveness of Varenicline versus Bupropion, Nicotine-Replacement Therapy, and Unaided Cessation in Greece. Clin Ther 2012; 34: 1803-1814
• 22 Bae JY, Kim CH, Lee EK. Evaluation of cost-utility of varenicline compared with existing smoking-cessation therapies in South Korea. Value Health 2009; 3: 70-73
• 23 Bolin K, Mörk A, Wilson K. Smoking-cessation therapy using varenicline: the cost-utility of an additional 12-week course of varenicline for the maintenance of smoking abstinence. J Eval Clin Pract 2009; 15: 478-485
• 24 Bolin K, Wilson K, Benhaddi H et al. Cost-effectiveness of varenicline compared with nicotine patches for smoking cessation--results from four European countries. Eur J Public Health 2009; 19: 650-654
• 25 Bolin K, Lindgren B, Willers S. The Cost Utility of Bupropionin Smoking Cessation Health Programs. Chest 2006; 129: 651-660
• 26 Bolin K, Mörk A, Willers S et al. Varenicline as compared to bupropion in smoking-cessation therapy—Cost–utility results for Sweden 2003. Respir Med 2008; 102: 699-710
• 27 Hoogendoorn M, Welsing P, Rutten-van Mölken MP. Cost-effectiveness of varenicline compared with bupropion, NRT, and nortriptyline for smoking cessation in the Netherlands. Curr Med Res Opin 2008; 24: 51-61
• 28 Howard P, Knight C, Boler A et al. Cost-Utility Analysis of Varenicline versus Existing Smoking Cessation Strategies using the BENESCO Simulation Model. Pharmaoeconomics 2008; 26: 497-511
• 29 Knight C, Howard P, Baker CL et al. The cost-effectiveness of an extended course (12+12 weeks) of varenicline compared with other available smoking cessation strategies in the United States. Vaue Health 2010; 13: 209-214
• 30 Linden K, Jormanaien V, Linna M et al. Cost effectiveness of vareniciline vs. bupropion and unaided cessation for smoking cessation in a cohort of Finnish adult smokers. Curr Med Res Opin 2010; 26: 549-560
• 31 Orme ME, Hogue SL, Kennedy LM et al. Development of the health and economic consequences of smoking interactive model. Tob Control 2001; 10: 55-61
• 32 von Wartburg M, Raymond V, Paradis PE. The long-term cost-effectiveness of varenicline (12-week standard course and 12+12-week extended course) vs. other smoking cessation strategies in Canada. Int J Clin Pract 2014; 68: 639-646
• 33 Halpern MT, Dirani R, Schmier JK. The cost effectiveness of varenicline for smoking cessation. Manag Care Interface 2007; 20: 18-25
• 34 Bae JY, Kim CH, Lee EK. Evaluation of Cost-Utility of Varenicline Compared with Existing Smoking Cessation Therapies in South Korea. Value Health 2009; 12: 70-73
• 35 Heitjan DF, Asch DA, Ray R et al. Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment. Pharmacogenomics J 2008; 8: 391-399
• 36 Hagen G, Wisloff T, Klemp M. Cost-Effectiveness of Varenicline, Bupropion and Nicotine Replacement Therapy for Smoking Cessation. Norwegian Knowledge Centre for the Health Services 2010; 1-48
• 37 Song F, Raftery J, Aveyard P et al. Cost-Effectiveness of Pharmacological Interventions for Smoking Cessation: a Literature Review and a Decision Analytic Analysis. Med Decis Making 2002; 22: 26-37
• 38 Igarashi A, Takuma H, Fukuda T et al. Cost-Utility Analysis of Varenicline, an Oral Smoking-Cessation Drug, in Japan. Pharmaoeconomics 2009; 27: 247-261
• 39 Salize HJ, Merkel S, Reinhard I et al. Cost-effective Primary Care–Based Strategies to Improve Smoking Cessation. Arch Intern Med 2009; 169: 230-235
• 40 Ruger JP, Lazar CM. Economic Evaluation of Pharmaco- and Behavioral Therapies for Smoking Cessation: A Critical and Systematic Review of Empirical Research. Annu. Rev. Public. Health. 2012; 33: 279-305
• 41 An LC, Schillo BA, Kavanaugh AM et al. Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tob Control 2006; 15: 286-293
• 42 Shearer J, Shanahan M. Cost effectiveness analysis of smoking cessation interventions. Aust N Z J Public Health 2006; 30: 428-434