Return on investment of different combinations of bupropion SR dose and behavioral treatment for smoking cessation in a health care setting: an employer's perspective

Abstract

The net benefit (i.e., benefits minus costs) of sustained-release (SR) bupropion for smoking cessation from an employer's perspective has previously been evaluated in clinical trials including frequent, in-person behavioral counseling and manufacturer recommended dosing but not in actual practice settings and lower dosing.

Objectives: The objective of this research was to determine the return on investment (ROI) and internal rate of return (IRR) from an employer's perspective of two dosing schedules of bupropion SR in combination with behavioral interventions of minimal intensity (tailored mailings, TM) or moderate intensity (proactive telephone calls, PTC) in an actual practice setting.

Methods: An open-label, randomized trial with 1-year follow-up was conducted in a large health system (Group Health Cooperative) based in Seattle, WA. Participants included 1524 adult smokers interested in quitting smoking. Participants were randomly assigned to receive 150 mg of bupropion SR daily and PTC (n=382), 150 mg of bupropion SR daily and TM (n=381), 300 mg of bupropion SR daily and PTC (n=383) or 300 mg of bupropion SR daily and TM (n=378). Sufficient medications for 8 weeks of dosing were provided to patients. The primary outcome measure of the field trial was self-reported point-prevalence 7-day nonsmoking status at 12 months, and the primary outcome measures of the economic analysis were employer net benefit, employer ROI, and the ROI-associated IRR using 2002 dollars.

Results: Using net benefit, the 300-mg/PTC and the 150-mg/PTC treatments were approximately equally preferred. Using ROI or IRR, both the 150-mg/TM and 150-mg/PTC treatments were about equally preferred, with IRR values of 31.7% and 31.4%, respectively. Under a pessimistic scenario regarding effectiveness and costs, 150 mg/PTC became more cost-effective than 150 mg/TM, and employer IRR for 150 mg/PTC was 13%. Under an optimistic scenario IRR exceeded 45% for all treatments.

Conclusions: These results suggest that employers can receive competitive returns on investment from sponsoring smoking cessation programs, that 150 mg of bupropion doses yield better returns than 300-mg doses, and that PTC treatments should be preferred to TM if smoking cessation rates in the targeted employee population are lower than those in the study population.