The Cost-Effectiveness of Nicotine Replacement Therapy Sampling in Primary Care: a Markov Cohort Simulation Model.

Background: Pharmacotherapies remain a central focus of successful tobacco control, but uptake remains very low. Objective: To estimate the cost effectiveness of a primary care nicotine replacement therapy (NRT) sampling intervention. Design: A Markov cohort simulation model was constructed to conduct cost-effectiveness analyses. Clinical trial results were used to initialize the Markov model. All other model parameters were derived from the literature. The study was conducted over a lifetime horizon, from the payers' budgetary perspective. Participants: Smokers with a primary care visit. Intervention: Medication sampling, which provided short, starter packets of NRT (nicotine patch and lozenge) to smokers in the primary care setting. Main Measures: Lifetime healthcare expenditures, quality-adjusted life years, and life years. Key Results: Medication sampling was the dominant strategy compared to standard care. Our intervention cost $75, yielding a discounted lifetime savings of $1065 in healthcare expenditures, and increased both discounted quality-adjusted life years and discounted life years by 0.01. One-way sensitivity analyses showed that medication sampling remained dominant in plausible ranges except when it failed to increase cessation relative to standard care. Probabilistic sensitivity analyses confirmed that medication sampling was dominant in 94.1% of the simulated cases, with an implementation cost of $74 (95% CI $73–$76) and discounted lifetime savings in health expenditures of $1061 (− $1106 to − $1,017), increasing quality-adjusted life years by 0.008 (0.0085–0.0093) and life years by 0.008 (0.0081–0.0089). Conclusion: Medication sampling, an easily implementable, scalable and low-cost intervention to encourage smoking cessation, is cost saving and improves quality of life. [ABSTRACT FROM AUTHOR]