Study: Standard Varenicline Highly Cost-Effective

Stetoscope with dollar shaped cord isolated on white

Sometimes, more isn’t better.

That was the case for Quitting Using Intensive Treatments Study (QUITS) participants who smoked. On average, 12 weeks of just varenicline medication plus coaching on how to address tobacco use was the most cost-effective treatment.

UW-CTRI researchers published the results in JAMA Network Open.

QUITS compared standard varenicline alone treatment for 12 weeks versus 24 weeks. Researchers contrasted that with enhanced varenicline medication combined with nicotine patches for those same lengths.

“Varenicline alone for 12 weeks was highly beneficial and very cost-effective,” said UW-CTRI lead author Dr. Marlon Mundt.

Dr. Marlon Mundt
Dr. Marlon Mundt, PhD

They found 12 weeks of varenicline plus patches cost $199 more per patient than 12 weeks of varenicline alone but produced virtually identical quit rates.

Similarly, 24 weeks of just varenicline cost an additional $847 per patient in contrast to 12 weeks but also generated similar tobacco abstinence results.

“It didn’t add value in terms of health outcomes for patients to extend varenicline treatment past 12 weeks, or to combine it with the patch,” Mundt said. “Twenty-four weeks of varenicline plus the patch technically helped the most people quit but it was by such a small margin that the observed health benefit doesn’t justify the added costs and burden to patients.”

Giving participants the standard 12 weeks of just varenicline carried an incremental cost-effectiveness ratio of $4579 per patient health-related “quality-adjusted life-year.”

The quality-adjusted life-year is a health economic measure of how treatments improve or extend patients’ lives. It evaluates the health and economic value of medical interventions. One quality-adjusted life year equates to one year in perfect health.

QUITSMundt said $4579 per year of perfect health was highly encouraging. “That figure shows our health care practitioners that prescribing the standard dosing of varenicline for 12 weeks is the most cost-effective option relative to other treatments and that standard pharmacotherapy offers better patient health outcomes at lower costs.”

In contrast, the enhanced treatment of 24 weeks of varenicline plus patches and coaching requires an additional $90 million per quality-adjusted life-year to gain an additional health benefit above and beyond what a patient would receive from 12 weeks of standard varenicline and coaching.

All QUITS participants received coaching on how to address their tobacco use. This included six 15-minute counseling sessions with UW-CTRI health counselors on how to address tobacco use. Intervention costs included counseling and medications.

Mundt said he was encouraged by the cost-effectiveness results, even though some prior research had indicated combination therapy was a promising treatment. “Our results convincingly show that 12 weeks of just varenicline is the most cost-effective option with the best health outcomes.”

He observed that patients’ adherence rates may have decreased when treatment intensity increased.

The researchers hope this cost-effectiveness analysis provides evidence to policymakers, insurers, and healthcare professionals so they can use limited resources to help people quit smoking, chewing, or vaping tobacco products.

Mundt MP, Stein JH, Fiore MC, Baker TB. (2024) Economic Evaluation of More Intense vs Standard Varenicline Treatment for Tobacco Cessation. JAMA Network Open. 2024;7(4):e248727. Online April 24, 2024.