{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:30:09Z","timestamp":1791563409812,"version":"4.3.4"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Smoking is the leading preventable cause of death and illness in the US. Identifying cost-effective smoking cessation treatment may increase the likelihood that health systems deliver such treatment to their patients who smoke.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the cost-effectiveness of standard vs enhanced varenicline use (extended varenicline treatment or varenicline in combination with nicotine replacement therapy) among individuals trying to quit smoking.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This economic evaluation assesses the Quitting Using Intensive Treatments Study (QUITS), which randomized 1251 study participants who smoked into 4 conditions: (1) 12-week varenicline monotherapy (n\u2009=\u2009315); (2) 24-week varenicline monotherapy (n\u2009=\u2009311); (3) 12-week varenicline combination treatment with nicotine replacement therapy patch (n\u2009=\u2009314); or (4) 24-week varenicline combination treatment with nicotine replacement therapy patch (n\u2009=\u2009311). Study enrollment occurred in Madison and Milwaukee, Wisconsin, between November 11, 2017, and July 2, 2020. Statistical analysis took place from May to October 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was 7-day point prevalence abstinence (biochemically confirmed with exhaled carbon monoxide level \u22645 ppm) at 52 weeks. The incremental cost-effectiveness ratio (ICER), or cost per additional person who quit smoking, was calculated using decision tree analysis based on abstinence and cost for each arm of the trial.<\/jats:p><\/jats:sec>Results<\/jats:title>Of the 1251 participants, mean (SD) age was 49.1 (11.9) years, 675 (54.0%) were women, and 881 (70.4%) completed the 52-week follow-up. Tobacco cessation at 52 weeks was 25.1% (79 of 315) for 12-week monotherapy, 24.4% (76 of 311) for 24-week monotherapy, 23.6% (74 of 314) for 12-week combination therapy, and 25.1% (78 of 311) for 24-week combination therapy, respectively. The total mean (SD) cost was $1175 ($365) for 12-week monotherapy, $1374 ($412) for 12-week combination therapy, $2022 ($813) for 24-week monotherapy, and $2118 ($1058) for 24-week combination therapy. The ICER for 12-week varenicline monotherapy was $4681 per individual who quit smoking and $4579 per quality-adjusted life-year (QALY) added. The ICER for 24-week varenicline combination therapy relative to 12-week monotherapy was $92\u202f000\u202f000 per additional individual who quit smoking and $90\u202f000\u202f000 (95% CI, $15\u202f703 to dominated or more costly and less efficacious) per additional QALY.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This economic evaluation of standard vs enhanced varenicline treatment for smoking cessation suggests that 12-week varenicline monotherapy was the most cost-effective treatment option at the commonly cited threshold of $100\u202f000\/QALY. This study provides patients, health care professionals, and other stakeholders with increased understanding of the health and economic impact of more intensive varenicline treatment options.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.8727","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T15:33:32Z","timestamp":1714404812000},"page":"e248727","source":"Crossref","is-referenced-by-count":4,"title":["Economic Evaluation of Enhanced vs Standard Varenicline Treatment for Tobacco Cessation"],"prefix":"10.1001","volume":"7","author":[{"given":"Marlon P.","family":"Mundt","sequence":"first","affiliation":[{"name":"Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"Center for Tobacco Research and Intervention, University of Wisconsin 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