EFFICACY AND COST-EFFECTIVENESS ANALYSIS OF NRT PATCHES VS. ONCE-DAILY BUPROPION SR: A RETROSPECTIVE CHART REVIEW
Catherine D Johnson, Linda M Lucas, and Mari A Uchishiba

BACKGROUND: Many studies have shown that smoking cessation is cost-effective; however, there have been no pharmacoeconomic trials directly comparing nicotine replacement therapy (NRT) with bupropion SR, the current mainstays of pharmacologic therapy for nicotine dependence.

OBJECTIVE: To evaluate and compare clinical efficacy and cost-effectiveness of either NRT or once-daily bupropion SR using patient-reported continuous six-month quit rates and pharmacoeconomic evaluation.

METHODS: Retrospective data on six-month abstinence rates were obtained on 287 Veterans Affairs people who enrolled in our smoking cessation programs from August 1997 to May 1998. These subjects received either NRT patches or once-daily bupropion SR along with counseling on behavioral modification. Quit rates were calculated to compare the efficacy of NRT versus once-daily bupropion SR. Pharmacoeconomic cost analysis data were calculated to determine actual and guideline cost of each medication group. The costs of success and failure of both NRT patches and bupropion SR were also determined.

RESULTS: Six-month quit rates were not significantly different in NRT patches versus bupropion SR groups (27.7% vs. 31%; p > 0.702). Pharmacoeconomic analysis revealed that overall cost of therapy was $158 for medication/patient receiving NRT versus $67/patient taking bupropion SR. Actual cost of success for NRT was $140/patient compared with $199/patient if doses matched guideline recommendations. Actual cost of failure for NRT was $166/patient compared with $138/patient if guideline doses were used. Patients who successfully quit smoking with NRT used pharmacologic treatment for approximately three weeks less than the guideline time period; patients who failed with NRT used therapy about 10 days longer than the guideline time. Actual cost of success for bupropion SR was $74/patient compared with $42/patient if guideline doses were used. Cost of failure with bupropion SR was $63/patient compared with $32/patient if guidelines were followed. Patients successful with bupropion SR used the treatment six weeks longer than our guideline, while patients who failed on bupropion SR used the therapy eight weeks beyond the guideline.

CONCLUSIONS: NRT and bupropion SR were equally efficacious; however, bupropion SR was more cost-effective than NRT. Increasing the duration of therapy with NRT beyond our guideline period increased the cost of failure.

J Pharm Technol 2001;17:140-6.