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Smoking Cessation Treatment and Outcomes Patterns Simulation: A New Framework for Evaluating the Potential Health and Economic Impact of Smoking Cessation Interventions

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Abstract

Background

Most existing models of smoking cessation treatments have considered a single quit attempt when modelling long-term outcomes.

Objective

To develop a model to simulate smokers over their lifetimes accounting for multiple quit attempts and relapses which will allow for prediction of the long-term health and economic impact of smoking cessation strategies.

Methods

A discrete event simulation (DES) that models individuals’ life course of smoking behaviours, attempts to quit, and the cumulative impact on health and economic outcomes was developed. Each individual is assigned one of the available strategies used to support each quit attempt; the outcome of each attempt, time to relapses if abstinence is achieved, and time between quit attempts is tracked. Based on each individual’s smoking or abstinence patterns, the risk of developing diseases associated with smoking (chronic obstructive pulmonary disease, lung cancer, myocardial infarction and stroke) is determined and the corresponding costs, changes to mortality, and quality of life assigned. Direct costs are assessed from the perspective of a comprehensive US healthcare payer ($US, 2012 values). Quit attempt strategies that can be evaluated in the current simulation include unassisted quit attempts, brief counselling, behavioural modification therapy, nicotine replacement therapy, bupropion, and varenicline, with the selection of strategies and time between quit attempts based on equations derived from survey data. Equations predicting the success of quit attempts as well as the short-term probability of relapse were derived from five varenicline clinical trials.

Results

Concordance between the five trials and predictions from the simulation on abstinence at 12 months was high, indicating that the equations predicting success and relapse in the first year following a quit attempt were reliable. Predictions allowing for only a single quit attempt versus unrestricted attempts demonstrate important differences, with the single quit attempt simulation predicting 19 % more smoking-related diseases and 10 % higher costs associated with smoking-related diseases. Differences are most prominent in predictions of the time that individuals abstain from smoking: 13.2 years on average over a lifetime allowing for multiple quit attempts, versus only 1.2 years with single quit attempts. Differences in abstinence time estimates become substantial only 5 years into the simulation. In the multiple quit attempt simulations, younger individuals survived longer, yet had lower lifetime smoking-related disease and total costs, while the opposite was true for those with high levels of nicotine dependence.

Conclusion

By allowing for multiple quit attempts over the course of individuals’ lives, the simulation can provide more reliable estimates on the health and economic impact of interventions designed to increase abstinence from smoking. Furthermore, the individual nature of the simulation allows for evaluation of outcomes in populations with different baseline profiles. DES provides a framework for comprehensive and appropriate predictions when applied to smoking cessation over smoker lifetimes.

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Acknowledgments

Funding

Funding for this project was provided by Pfizer Inc.

Role of the funding source

Employees of Pfizer Inc. (Jenő P. Marton, Richard J. Willke and Dale Rublee) were involved in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review and approval of the manuscript. Jenő P. Marton was an employee of Pfizer Inc. at the time the model was being designed and developed.

Conflicts of interest

Denis Getsios, Nikhil Revankar, Alexandra J. Ward, and K. Jack Ishak are employees of United BioSource Corporation, who were paid consultants to Pfizer Inc. in connection with the development of the manuscript at the time of study conduct. James G. Xenakis was an employee of United BioSource Corporation at the time the model was being designed and developed. Jenő P. Marton, Dale Rublee, and Richard J. Willke were employees of Pfizer Inc. at the time of study conduct.

Author contributions

DG, JPM, NR, AW, RW, DR, KJI, and JX participated in the design of the model, identification of data sources, conduct of data analyses, and implementing the design. Each author also contributed to the interpretation of data and results, drafting the manuscript, and has approved the final version. Denis Getsios will serve as a guarantor for the overall content of the manuscript.

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Authors and Affiliations

  1. United BioSource Corporation, 430 Bedford Street, Suite 300, Lexington Office Park, Lexington, MA, 02420, USA

    Denis Getsios, Nikhil Revankar, Alexandra J. Ward, K. Jack Ishak & James G. Xenakis

  2. Pfizer Inc., New York, NY, USA

    Jenő P. Marton, Richard J. Willke & Dale Rublee

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  1. Denis Getsios
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Correspondence to Denis Getsios.

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Getsios, D., Marton, J.P., Revankar, N. et al. Smoking Cessation Treatment and Outcomes Patterns Simulation: A New Framework for Evaluating the Potential Health and Economic Impact of Smoking Cessation Interventions. PharmacoEconomics 31, 767–780 (2013). https://doi.org/10.1007/s40273-013-0070-5

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