A Cost-Utility Study of Smoking Cessation Interventions for Patients with Chronic Obstructive Pulmonary Disease in Thailand

Background: Evidence indicates that smoking cessation is the intervention that could slow the decline of lung function in patients with chronic obstructive pulmonary disease (COPD). Several pharmacological therapies for smoking cessation were available in Thailand. However, no cost-effectiveness evidence of smoking cessation intervention in Thailand has been reported. Objective: To estimate cost-utility of smoking cessation intervention in COPD patients. Materials and Methods: A lifetime Markov model of varenicline or bupropion in COPD patients willing to quit smoking compared to nortriptyline was conducted from a Thai societal perspective. The model consisted of six health states including 1) mild COPD, 2) moderate COPD, 3) severe COPD, 4) very severe COPD, 5) lung cancer, and 6) death. All inputs were determined by literature sources. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained was calculated. One-way and probabilistic sensitivity analyses were also conducted. The willingness-to-pay (WTP) 160,000 Thai baht (THB) was used as WTP threshold. Results: Compared to nortriptyline, varenicline was cost-effective with ICER of 50,446 THB/QALY gained, while bupropion was not cost-effective with ICER of 841,982 THB/QALY gained. Compared to bupropion, varenicline was also cost-effective with ICER of 14,200 THB/QALY. One-way sensitivity analysis indicated that incidence of lung cancer was a major driver of the model. Probabilistic sensitivity analysis indicated that varenicline had 98% chance to be cost-effective, while bupropion had 87% chance to be cost-effective at the WTP of 160,000 THB. Conclusion: The authors’ findings revealed that varenicline is the most cost-effective strategy for smoking cessation in COPD patients compared to nortriptyline and bupropion. Policy makers should consider varenicline to be in their benefit packages as a smoking cessation intervention for COPD patients. Keywords: Cost-utility analysis, Smoking cessation intervention, Chronic obstructive pulmonary disease, Thailand