The lifetime costs and benefits of subsidizing the cost of nicotine replacement therapy in Sweden
Despite its declining trend, smoking is still among the top public health problems in Sweden. Treatment with nicotine replacement therapy (NRT) during an attempt to quit smoking increases the likelihood of success by about 55%. However, paying out of pocket to buy over the counter can hinder their use. This study aims therefore to assess the cost-effectiveness of subsidizing the cost of NRT for smokers attempting to quit compared to the 'current practice' in Sweden.
A homogenous cohort-based Markov model is used to assess the lifetime costs and effects of subsidized NRT from a payer and societal perspective. Data to populate the model are retrieved from the literature and, selected parameters are varied in a deterministic and probabilistic sensitivity analyses to assess robustness of model outputs. The absolute treatment effectiveness of NRT in this study is 4.2% (2.1-8.1%) more quitters compared to the current practice, which is estimated by applying the relative risk ratio of NRT from the literature to a baseline quit rate of 7.7% calculated from a survey data. All costs are presented in € 2021.
The intervention was estimated to cost € 525 (393–656) per person. A total subsidy of NRT would yield a health gain of 0.032 (0.029 – 0.032) quality adjusted life years (QALY) at an additional cost of € 436 (376 – 483) per person compared to current practice from a payer perspective, that is an incremental cost effectiveness ratio of 13 670 (11 857 – 15 989) € per QALY. From a societal perspective, subsidized NRT is a dominant alternative. Subsidizing NRT has a potential of being cost-saving alternative to the society. Even in a narrower healthcare payer perspective, the ICER would fall in to a 'moderate' cost per QALY as per the classification by the National Board of Health and Welfare of Sweden.