Researchers from the Institute for Public Health, University of Calgary, Canada, recently released findings from a study in which they performed a cost-utility analysis of funding smoking cessation programs for patients with Crohn’s Disease (CD). The study entitled, “Funding a smoking cessation program for Crohn’s disease: an economic evaluation” was published in the most recent edition of The American Journal of Gastroenterology.

Background terminology:

• Quality adjusted life years (QALY): a measure used in assessing the value for money of a medical intervention by the effects it has on both the quality and the quantity of a patient’s life. It is number of years of life that would be added by the intervention.
• Cost-utility analysis: in healthcare it measures QALYs by the value for money gained or lost between two different interventions on health outcomes.

CD is a debilitating disease caused by inflammation of the lining of a patient’s digestive tract. The inflammation often spreads deep into affected tissues. The inflammation can involve the large intestine, small intestine or both.  Studies have shown that CD patients who smoke are at a higher risk of having flare up and requiring surgical interventions to alleviate their symptoms. Therefore, smoking cessation initiatives should most likely be implemented for this population.

Currently, there is very little data available as to the cost-effectiveness of implementing smoking cessation programs. This study was an effort by these researchers to close this data gap by performing a cost-utility analysis of funding smoking cessation programs for patients with CD, and the budgetary impact the programs would have on certain western healthcare systems.

Study Results:

The investigators compared 5 different smoking cessation strategies by the costs saved and increased QALYs over a 5 year period, including:

1. No Program: Recommendation to quit smoking without any direct counseling or prescription of a smoking cessation medication.
2. Counseling: Individual counseling once a week for 6 weeks led by a mental health professional.
3. Nicotine Replacement Therapy (NRT): nicotine patch
4. NRT+Counseling: A combination of the nicotine patch and individual counseling.
5. Varenicline (Chantix): Standard dosage of 1 g per day for 12 weeks

Budgetary impact analysis for each program was calculated for both the US and Canadian healthcare system expenditures.

As any reader might have expected, the costs saved for all the programs were significant in comparison to having patients not participate in any smoking cessation strategy.  The order from most to least cost-effective strategies were found to be as follows:

1. Varenicline (cost: $55,614, QALY: 3.70)
2. NRT+Counseling (cost: $58,878, QALY: 3.69)
3. NRT (cost: $59,540, QALY: 3.69)
4. Counseling (cost: $61,029, QALY: 3.68)
5. No Program (cost: $63,601, QALY: 3.67)

The budgetary analysis indicated that not providing a program could cost the Canadian Health Care System $128.3 million over 5 years, while the implementation of the varenicline strategy could save it more than $16.1 million. If the United States initiated the varenicline strategy, the savings could be upwards of $61 million.

A surprising study finding was that there was little variation or increase in QALY among the different smoking cessation strategies.

When discussing the study findings importance the authors state, “Our analysis demonstrates that targeting newly diagnosed CD patients who smoke with varenicline would save the Canadian health-care system over $16.1 million across 5 years. Importantly, the cost savings would be considerably higher if the future potential personal health and societal costs arising from the other well-recognized long-term complications of smoking such as cardiovascular disease and cancer were also considered.”

They do, however, caution physicians that are considering subscribing varenicline to their patients that “they should be aware of the common adverse events (i.e., anxiety and nausea). In addition, the Food and Drug Administration (FDA) issued a warning that neuropsychiatric symptoms have been reported in patients taking Varenicline. In addition, because studies on the effect of Varenicline on CD prognosis are lacking, gastroenterologists should follow their patients carefully when prescribing medications for smoking cessation.”