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Date: Wed, 22 Sep 2010 01:11:07 -0400 (EDT)
From: David P. Dillard <[log in to unmask]>
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Subject: TOBACCO CIGARETTES CIGARS AND SMOKING: CESSATION QUITING STOPPING:
Pharmacologic-Based Strategies for Smoking Cessation
.
TOBACCO CIGARETTES CIGARS AND SMOKING: CESSATION QUITING STOPPING:
Pharmacologic-Based Strategies for Smoking Cessation
Pharmacologic-Based Strategies for Smoking Cessation
http://www.cadth.ca/index.php/en/hta/reports-publications/
search/publication/2666
A shorter URL for the above link:
http://tinyurl.com/2czac62
The Canadian Agency for Drugs and Technologies in Health (CADTH) conducted a
review to evaluate the clinical and cost-effectiveness of pharmacologic agents
for smoking cessation.
To help policy-makers, health care providers, and consumers make well-informed
decisions, our completed research and findings provide:
an examination of clinical effectiveness and cost-effectiveness based on the
most recent evidence available in the public domain
identification of planning and equity issues associated with optimal treatment
strategies.
Summary Reports
Executive Summary
http://www.cadth.ca/media/pdf/H0486_Executive_Summary_e.pdf
Report in Brief
http://www.cadth.ca/media/pdf/H0486_RIB_e.pdf
Final Report
Technology Report
http://www.cadth.ca/media/pdf/H0486_Smoking_Cessation_tr_e.pdf
This report has been extensively peer-reviewed by external clinical and
methodological experts.
TABLE OF CONTENTS
EXECUTIVE SUMMARY
ABBREVIATIONS
GLOSSARY
INTRODUCTION
1
1.1 Background and Setting in Canada
1.2 Overview of Technology
1.2.1 Nicotine replacement therapy
1.2.2 Bupropion
1.2.3 Varenicline
2 THE ISSUE
OBJECTIVES
4 CLINICAL REVIEW
4.1 Methods
4.1.1 Literature searches
4.1.2 Selection criteria
4.1.3 Selection method
4.1.4 Data extraction strategy
4.1.5 Strategy for validity assessment
4.1.6 Data analysis methods
4.2 Results
4.2.1 Quantity of research available
4.2.2 Study characteristics
4.2.3 Data analyses and synthesis
5 ECONOMIC ANALYSIS
5.1 Review of Economic Studies: Methods
5.1.1 Literature searches
5.1.2 Selection criteria
5.1.3 Selection method
5.1.4 Data extraction strategy
5.1.5 Strategy for validity assessment
5.1.6 Data analysis methods
5.2 Review of Economic Studies: Results
5.2.1 Study selection
5.2.2 Study characteristics
5.2.3 Results from included studies
5.2.4 Quality assessment
5.3 Primary Economic Evaluation: Methods
5.3.1 Types of economic evaluation
5.3.2 Target population
5.3.3 Comparators
5.3.4 Perspective
5.3.5 Effectiveness
5.3.6 Time horizon
5.3.7 Modelling
5.3.8 Valuing outcomes
5.3.9 Resource use and costs Pharmacologic-based Strategies for Smoking
Cessation:
Clinical and Cost-Effectiveness Analyses
5.3.10 Discount rate
5.3.11 Variability and uncertainty
5.4 Primary Economic Evaluation: Results
5.4.1 Among the general population of smokers, what is the cost-effectiveness
of
varenicline compared with that of bupropion and that of NRT?
5.4.2 Among the general population of smokers using varenicline or bupropion or
NRT, what is the cost-effectiveness of adding a behavioural support program to
drug therapy?
5.4.3 What is the impact of copayment (of insurance claim) or payment (i.e.,
purchase drug as over-the-counter product) on the cost-effectiveness of drugs
used for smoking cessation therapy?
5.4.4 Among smokers, what is the cost-effectiveness of treating specific
patient populations with varenicline or bupropion or NRT, including a
combination of these agents with behavioural support programs?
6 HEALTH SERVICES IMPACT
6.1 Population Impact
6.2 Budget Impact
6.2.1 Adopting strategies with optimal cost-effectiveness
6.2.2 Implementing payment or copayment programs
7 Issues for willingness of smokers to pay
7.1 Methods
7.1.1 Literature searches
7.1.2 Selection criteria
7.1.3 Data selection and analysis
7.2 Results
8 Planning issues for optimal treatment strategies
8.1 Methods
8.1.1 Literature searches
8.1.2 Selection criteria
8.1.3 Data selection and analysis
8.2 Results
8.2.1 General issues
8.2.2 Issues of specific populations
8.2.3 Accountability
9 Publicly funded programs in Canada
9.1 Methods
9.2 Results
10 DISCUSSION
10.1 Summary of Results
Clinical
10.1.1 Economic
10.1.2 Comparison with relevant recent literature
10.2 Strengths and Weaknesses of This Assessment
10.2.1 Clinical
10.2.2 Economic
10.3 Generalizability of Findings
10.3.1 Clinical
10.3.2 Economic
10.4 Knowledge Gaps
10.4.1 Clinical
10.4.2 Economic
Pharmacologic-based Strategies for Smoking Cessation:
Clinical and Cost-Effectiveness Analyses
CONCLUSIONS
REFERENCES
APPENDIX 1: Literature Search Strategy
APPENDIX 2: Selected Reports for Clinical Review
APPENDIX 3: Data Extraction Form and Quality Assessment for
Clinical-Effectiveness Studies
APPENDIX 4: Included Studies for Questions 1-4, 11, 12
APPENDIX 5: Network Diagrams Connecting Placebo-Controlled and Head-to-Head
Trials
APPENDIX 6: Characteristics of the Included Trials
APPENDIX 7: Quality Assessment of the Included Trials
APPENDIX 8: Clinical Effects on Cessation Rates and Relapse
APPENDIX 9: Data Extraction Form for Economic Studies
APPENDIX 10: Excluded Economic Studies
APPENDIX 11: Selected Reports for Economic Review
APPENDIX 12: Included Economic Studies
APPENDIX 13: Quality Assessment of Economic Studies
APPENDIX 14: Transition Probabilities for Chronic Condition Model
APPENDIX 15: Calculation of All-Cause Mortality by Smoking Status
APPENDIX 16: Methods for the Analysis of the Canadian Community Health Survey
APPENDIX 17: Utility Scores for Health States by Age, Gender, and/or Smoking
Status
APPENDIX 18: Intervention Costs for Economic Models Other Than the General
Population
APPENDIX 19: Annual Direct Per-Patient Medical Cost
APPENDIX 20: Clinical Efficacy Data Used for Sensitivity Analyses
APPENDIX 21: Sensitivity Analyses for General Population Model
APPENDIX 22: MCS Results for General Population
APPENDIX 23: Calculation of Smokers Who Attempt To Quit Smoking
APPENDIX 24: EVPI by Age and Gender for General Population
APPENDIX 25: Sensitivity Analyses for Models for Cost-Effectiveness of Adding
Behavioural
Intervention
APPENDIX 26: MCS for Models for Cost-Effectiveness of Adding Behavioural
Intervention
APPENDIX 27: Sensitivity Analyses for Pay or Copay Models
APPENDIX 28: MCS Results for Pay or Copay Model
APPENDIX 29: Sensitivity Analyses of Models for Patients with Cardiovascular or
Smoking-
Related Diseases
APPENDIX 30: MCS Results for Models for Patients with Cardiovascular or Other
Smoking
Related Diseases
APPENDIX 31: Sensitivity Analyses of Models for Hospitalized Patients
APPENDIX 32: MCS Results for Hospitalized Patients
APPENDIX 33: Smoking Prevalence by Provinces in 2007 (Age 15+)
APPENDIX 34: Number (%) of Daily Smokers, By Age, Who Made At Least One Quit
Attempt in
the Past 12 Months (2004 2007)
APPENDIX 35: Summary of the Number of Claims and Expenditures for NRT,
Bupropion, and
Varenicline
APPENDIX 36: Average Cost Per Claim and Changes in the Number of Claims for
NRT,
Bupropion, and Varenicline (2004/2005 2007/2008)
APPENDIX 37: Estimated Number of Claims and Cost per Claim by Jurisdiction
APPENDIX 38: Data Extraction Sheet for Questions 11 and 12
APPENDIX 39: Selected Reports for Questions 11 and 12
Sincerely,
David Dillard
Temple University
(215) 204 - 4584
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