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Smoking Cessation Adjuncts Are Cost Effective Prior to Elective Revascularization
Hasan Nassereldine1, Katherine M Reitz2, Mikayla Lowenkamp3
1Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
Smoking cessation therapies before peripheral artery disease revascularization are cost effective. Varenicline and nicotine replacement therapy (NRT) offer the best value, improving patient outcomes and quality of life.
Area of Science:
- Vascular Surgery
- Health Economics
- Public Health
Background:
- Preoperative smoking cessation reduces postoperative complications.
- Smoking cessation therapies are cost-effective for many elective procedures.
- Cost-effectiveness for patients with peripheral artery disease (PAD) is not well-established.
Purpose of the Study:
- To evaluate the cost-effectiveness of preoperative smoking cessation therapies for PAD patients undergoing revascularization.
- To compare standard care, counseling, nicotine replacement therapy (NRT), varenicline, and bupropion.
Main Methods:
- A Markov model assessed cost-effectiveness in 65-year-old PAD patients.
- Data on therapy costs, effectiveness, and postoperative outcomes were used.
- Quality-adjusted life-years (QALYs) and a $100,000/QALY threshold were applied.
Main Results:
- Varenicline yielded the most quality-adjusted life-years (7.11 QALYs).
- Nicotine replacement therapy (NRT) and varenicline were the most cost-effective strategies.
- Varenicline was favored in 80.3% of probabilistic simulations.
Conclusions:
- Smoking cessation adjuncts are cost-effective prior to PAD interventions.
- Varenicline and NRT represent the most cost-effective smoking cessation strategies.
- Enhanced coverage for smoking cessation therapies in PAD patients is recommended.
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