{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:03:46Z","timestamp":1779289426476,"version":"3.51.4"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Treatment with nicotine replacement therapy (NRT) during an attempt to quit smoking increases the likelihood of success by about 55%. However, out-of-pocket payment for NRT can hinder its use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims and Methods<\/jats:title><jats:p>This study aims therefore to assess the cost-effectiveness of subsidizing NRT in Sweden. A homogeneous cohort-based Markov model was used to assess the lifetime costs and effects of subsidized NRT from a payer and societal perspective. Data to populate the model were retrieved from the literature, and selected parameters were varied in deterministic and probabilistic sensitivity analyses to assess robustness of model outputs. Costs are presented in USD, year 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A 12-week treatment with NRT was estimated to cost USD 632 (474\u2013790) per person. From a societal perspective, subsidized NRT was a cost-saving alternative in 98.5% of the simulations. NRT is cost-saving across all ages, but the health and economic gains are somewhat larger among younger smokers from a societal perspective. When a payer perspective was used, the incremental cost-effectiveness ratio was estimated at 14 480 (11 721\u201318 515) USD per QALY which was cost-effective at a willingness to pay of 50 000 USD per QALY in 100 % of the simulations. Results were robust with realistic changes in the inputs during scenario and sensitivity analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Subsidizing NRT is potentially a cost-saving smoking cessation strategy from a societal perspective and cost-effective from a payer perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications<\/jats:title><jats:p>This study found that subsidizing NRT is potentially a cost-saving smoking cessation policy alternative compared to current practice from a societal perspective. From a healthcare payer perspective, subsidizing NRT is estimated to cost USD 14 480 to gain an extra QALY. NRT is cost-saving across all ages, but the health and economic gains are somewhat larger among younger smokers from a societal perspective. Moreover, subsidizing NRT removes the financial barriers that are mostly faced by socioeconomically disadvantaged smokers which might reduce health inequalities. Thus, future economic evaluations should further investigate the health inequality impacts with methods that are more suitable for this.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ntr\/ntad103","type":"journal-article","created":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T13:40:29Z","timestamp":1687873229000},"page":"1762-1769","source":"Crossref","is-referenced-by-count":2,"title":["Should Nicotine Replacement Therapy be Provided Free of Charge? A Cost-Utility Analysis in Sweden"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9556-0075","authenticated-orcid":false,"given":"Mihretab","family":"Gebreslassie","sequence":"first","affiliation":[{"name":"Centre for Epidemiology and Community Medicine , Stockholm , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Rosaria","family":"Galanti","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Community Medicine , Stockholm , Sweden"},{"name":"Department of Global Public Health, Karolinska Institute, Stockholm , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inna","family":"Feldman","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton","family":"Lager","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Community Medicine , Stockholm , Sweden"},{"name":"Department of Global Public Health, Karolinska Institute, Stockholm , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,6,27]]},"reference":[{"issue":"10292","key":"2023090711271940200_CIT0001","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"397","author":"Reitsma","year":"2021","journal-title":"Lancet"},{"key":"2023090711271940200_CIT0002","volume-title":"GBD Compare Data Visualization","author":"Institute for Health Metrics and Evaluation (IHME)","year":"2015"},{"issue":"1","key":"2023090711271940200_CIT0003","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1136\/tobaccocontrol-2016-053305","article-title":"Global economic cost of smoking-attributable diseases","volume":"27","author":"Goodchild","year":"2018","journal-title":"Tob Control."},{"key":"2023090711271940200_CIT0004","volume-title":"SAMH\u00c4LLSKOSTNADEN F\u00d6R R\u00d6KNINGSRELATERAD SJUKLIGHET I SVERIGE","author":"Andersson","year":"2017"},{"issue":"4","key":"2023090711271940200_CIT0005","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1056\/NEJMsa1211128","article-title":"21st-century hazards of smoking and benefits of cessation in the United States","volume":"368","author":"Jha","year":"2013","journal-title":"N Engl J Med."},{"issue":"7455","key":"2023090711271940200_CIT0006","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1136\/bmj.38142.554479.AE","article-title":"Mortality in relation to smoking: 50 years\u2019 observations on male British doctors","volume":"328","author":"Doll","year":"2004","journal-title":"BMJ"},{"issue":"1","key":"2023090711271940200_CIT0007","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1471-2458-8-2","article-title":"The relationship between smokers\u2019 motivation to quit and intensity of tobacco control at the population level: a comparison of five European countries","volume":"8","author":"Thyrian","year":"2008","journal-title":"BMC Public Health"},{"issue":"4","key":"2023090711271940200_CIT0008","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/S0749-3797(00)00124-0","article-title":"Smoking cessation with and without assistance","volume":"18","author":"Zhu","year":"2000","journal-title":"Am J Prev Med."},{"issue":"6","key":"2023090711271940200_CIT0009","doi-asserted-by":"crossref","first-page":"e011045","DOI":"10.1136\/bmjopen-2016-011045","article-title":"Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers","volume":"6","author":"Chaiton","year":"2016","journal-title":"BMJ Open"},{"issue":"9","key":"2023090711271940200_CIT0010","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1093\/ntr\/ntu052","article-title":"Natural history of attempts to stop smoking","volume":"16","author":"Hughes","year":"2014","journal-title":"Nicotine Tob Res."},{"issue":"12","key":"2023090711271940200_CIT0011","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.addbeh.2008.05.012","article-title":"Relapse to smoking after 1 year of abstinence: a meta-analysis","volume":"33","author":"Hughes","year":"2008","journal-title":"Addict Behav."},{"issue":"2","key":"2023090711271940200_CIT0012","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s002130100712","article-title":"Effect of oral nicotine dosing forms on cigarette withdrawal symptoms and craving: a systematic review","volume":"155","author":"West","year":"2001","journal-title":"Psychopharmacology (Berl)."},{"key":"2023090711271940200_CIT0013","first-page":"1465","article-title":"Nicotine replacement therapy versus control for smoking cessation. Cochrane Tobacco Addiction Group, ed","volume":"5","author":"Hartmann-Boyce","year":"2018","journal-title":"Cochrane Database Syst Rev."},{"key":"2023090711271940200_CIT0014","volume-title":"Nationella riktlinjer f\u00f6r prevention och behandling vid oh\u00e4lsosamma levnadsvanor","author":"Socialstyrelsen"},{"issue":"10","key":"2023090711271940200_CIT0015","doi-asserted-by":"crossref","first-page":"e0240411","DOI":"10.1371\/journal.pone.0240411","article-title":"Experiences of tobacco cessation including a prescription approach among patients in Swedish primary health care with a focus on socioeconomically disadvantaged areas. Myers B, ed","volume":"15","author":"Lepp\u00e4nen","year":"2020","journal-title":"PLoS One."},{"issue":"6","key":"2023090711271940200_CIT0016","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1136\/tc.2006.019539","article-title":"Nicotine replacement therapy, professional therapy, snuff use and tobacco smoking: a study of smoking cessation strategies in southern Sweden","volume":"16","author":"Lindstrom","year":"2007","journal-title":"Tob Control."},{"key":"2023090711271940200_CIT0017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4137\/TUI.S15628","article-title":"The economic impact of smoking and of reducing smoking prevalence: review of evidence","volume":"8","author":"Ekpu","year":"2015","journal-title":"Tob Use Insights"},{"key":"2023090711271940200_CIT0018","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/add.14090","article-title":"Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD: cost-effectiveness of smoking cessation in Spain","volume":"113","author":"Trapero-Bertran","year":"2018","journal-title":"Addiction."},{"issue":"2","key":"2023090711271940200_CIT0019","doi-asserted-by":"crossref","first-page":"e0148750","DOI":"10.1371\/journal.pone.0148750","article-title":"Cost effectiveness of free access to smoking cessation treatment in france considering the economic burden of smoking-related diseases. Gorlova OY, ed","volume":"11","author":"Cadier","year":"2016","journal-title":"PLoS One."},{"issue":"5","key":"2023090711271940200_CIT0020","doi-asserted-by":"crossref","first-page":"453","DOI":"10.2165\/00019053-200624050-00004","article-title":"Encouraging smokers to quit: the cost effectiveness of reimbursing the costs of smoking cessation treatment","volume":"24","author":"Kaper","year":"2006","journal-title":"PharmacoEcon."},{"issue":"4","key":"2023090711271940200_CIT0021","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1136\/tc.2006.017657","article-title":"Costs and benefits of smoking cessation aids: making a case for public reimbursement of nicotine replacement therapy in Australia","volume":"16","author":"Bertram","year":"2007","journal-title":"Tob Control."},{"issue":"1","key":"2023090711271940200_CIT0022","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/PHH.0000000000000302","article-title":"Impact of increasing coverage for select smoking cessation therapies with no out-of-pocket cost among the medicaid population in alabama, georgia, and maine","volume":"22","author":"Athar","year":"2016","journal-title":"J Public Health Manag Pract."},{"key":"2023090711271940200_CIT0023","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2147\/CEOR.S165576","article-title":"A cost&ndash;benefit analysis of smoking cessation prescription coverage from a US payer perspective","volume":"10","author":"Baker","year":"2018","journal-title":"Clin Outcomes Res"},{"issue":"14","key":"2023090711271940200_CIT0024","doi-asserted-by":"crossref","first-page":"3684","DOI":"10.1007\/s11606-021-07335-x","article-title":"The cost-effectiveness of nicotine replacement therapy sampling in primary care: a markov cohort simulation model","volume":"37","author":"Chen","year":"2022","journal-title":"J Gen Intern Med."},{"key":"2023090711271940200_CIT0025","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780192631770.003.0011","article-title":"Transferability of economic evaluation results","volume-title":"Economic Evaluation in Health Care: Merging Theory With Practice","author":"Drummond","year":"2001"},{"key":"2023090711271940200_CIT0026","article-title":"Eurostat","author":"Tobacco Consumption Statistics"},{"key":"2023090711271940200_CIT0027","volume-title":"Folkh\u00e4lsorapoort 2019","author":"Galanti","year":"2019"},{"key":"2023090711271940200_CIT0028","volume-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"Drummond","year":"2015"},{"issue":"7","key":"2023090711271940200_CIT0029","doi-asserted-by":"crossref","first-page":"551","DOI":"10.2165\/11590120-000000000-00000","article-title":"Economic evaluation of smoking-cessation therapies: a critical and systematic review of simulation models","volume":"30","author":"Bolin","year":"2012","journal-title":"PharmacoEcon."},{"issue":"1","key":"2023090711271940200_CIT0030","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1046\/j.1524-4733.2003.00234.x","article-title":"Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR task force on good research practices\u2014modeling studies","volume":"6","author":"Weinstein","year":"2003","journal-title":"Value Health."},{"issue":"6","key":"2023090711271940200_CIT0031","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.jval.2012.06.012","article-title":"Modeling good research practices\u2014overview: a report of the ispor-smdm modeling good research practices task force-1","volume":"15","author":"Caro","year":"2012","journal-title":"Value Health."},{"key":"2023090711271940200_CIT0032","volume-title":"Cost-Effectiveness of Varenicline, Bupropion and Nicotine Replacement Therapy for Smoking Cessation","author":"Hagen","year":"2010"},{"issue":"1","key":"2023090711271940200_CIT0033","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12916-021-02204-0","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"20","author":"Husereau","year":"2022","journal-title":"BMC Med."},{"issue":"5","key":"2023090711271940200_CIT0034","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1093\/ije\/dys126","article-title":"Cohort profile: the stockholm public health cohort","volume":"42","author":"Svensson","year":"2013","journal-title":"Int J Epidemiol."},{"issue":"4","key":"2023090711271940200_CIT0035","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1136\/tc.2005.015487","article-title":"Nicotine replacement therapy for long-term smoking cessation: a meta-analysis","volume":"15","author":"Etter","year":"2006","journal-title":"Tob Control."},{"issue":"1","key":"2023090711271940200_CIT0036","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1186\/1471-2458-13-592","article-title":"Long-term follow-up of a high- and a low-intensity smoking cessation intervention in a dental setting\u2013 a randomized trial","volume":"13","author":"Nohlert","year":"2013","journal-title":"BMC Public Health"},{"key":"2023090711271940200_CIT0037","author":"Befolkningsstatistik"},{"issue":"3","key":"2023090711271940200_CIT0038","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1136\/tc.2008.026898","article-title":"Health consequences of sustained smoking cessation","volume":"18","author":"Bjartveit","year":"2009","journal-title":"Tob Control."},{"issue":"1","key":"2023090711271940200_CIT0039","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/1471-2458-12-203","article-title":"Smoking and health-related quality of life in English general population: implications for economic evaluations","volume":"12","author":"Vogl","year":"2012","journal-title":"BMC Public Health"},{"key":"2023090711271940200_CIT0040","article-title":"Sociala avgifter \u00f6ver tid","author":"Ekonomifakta. ekonomifakta","year":"2021"},{"issue":"3","key":"2023090711271940200_CIT0041","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1177\/1403494815618843","article-title":"Sex differences in health care consumption in Sweden: a register-based cross-sectional study","volume":"44","author":"Osika Friberg","year":"2016","journal-title":"Scand J Public Health."},{"key":"2023090711271940200_CIT0042","year":"2019"},{"key":"2023090711271940200_CIT0043","first-page":"3","volume-title":"General guidelines for economic evaluations from the Pharmaceutical Benefits Board (LFNAR 2003:2)","author":"Edling","year":"2003"},{"issue":"6","key":"2023090711271940200_CIT0044","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.jval.2012.04.014","article-title":"Model Parameter Estimation and Uncertainty: a report of the ISPOR-SMDM modeling good research practices task force-6","volume":"15","author":"Briggs","year":"2012","journal-title":"Value Health."},{"key":"2023090711271940200_CIT0045","volume-title":"Tobaksbruk, riskbruk av alkohol, otillr\u00e4cklig fysisk aktivitet och oh\u00e4lsosamma matvanor \u2013 St\u00f6d f\u00f6r styrning och ledning","author":"Socialstyrelsen. Nationella riktlinjer f\u00f6r sjukdomsf\u00f6rebyggande metoder","year":"2011"},{"issue":"11","key":"2023090711271940200_CIT0046","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1007\/s40273-015-0307-6","article-title":"Reimbursement decisions for pharmaceuticals in sweden: the impact of disease severity and cost effectiveness","volume":"33","author":"Svensson","year":"2015","journal-title":"PharmacoEcon."},{"issue":"1","key":"2023090711271940200_CIT0047","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.healthpol.2020.09.002","article-title":"A systematic review of economic evaluations of public health interventions targeting alcohol, tobacco, illicit drug use and problematic gambling: using a case study to assess transferability","volume":"125","author":"Nystrand","year":"2021","journal-title":"Health Policy"},{"key":"2023090711271940200_CIT0048","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.puhe.2019.02.011","article-title":"The cost-effectiveness of public health interventions examined by the National Institute for Health and Care Excellence from 2005 to 2018","volume":"169","author":"Owen","year":"2019","journal-title":"Public Health."},{"issue":"6","key":"2023090711271940200_CIT0049","doi-asserted-by":"crossref","first-page":"497","DOI":"10.2165\/00019053-200826060-00004","article-title":"Cost-utility analysis of varenicline versus existing smoking cessation strategies using the BENESCO simulation model: application to a population of US adult smokers","volume":"26","author":"Howard","year":"2008","journal-title":"PharmacoEcon."},{"key":"2023090711271940200_CIT0050","volume-title":"R\u00f6kning. I Bartelink V, Lager A (Redakt\u00f6rer). Folkh\u00e4lsorapport 2019","author":"Galanti","year":"2019"},{"issue":"1","key":"2023090711271940200_CIT0051","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1471-2458-10-9","article-title":"Differences in socioeconomic and gender inequalities in tobacco smoking in Denmark and Sweden; a cross sectional comparison of the equity effect of different public health policies","volume":"10","author":"Eek","year":"2010","journal-title":"BMC Public Health"},{"issue":"1","key":"2023090711271940200_CIT0052","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1177\/0272989X15583266","article-title":"Distributional cost-effectiveness analysis: a tutorial","volume":"36","author":"Asaria","year":"2016","journal-title":"Med Decis Making."}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntad103\/50842617\/ntad103.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/25\/11\/1762\/51408829\/ntad103.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/25\/11\/1762\/51408829\/ntad103.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T21:25:33Z","timestamp":1702675533000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/25\/11\/1762\/7208612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,27]]},"references-count":52,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,6,27]]},"published-print":{"date-parts":[[2023,9,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntad103","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,6,27]]}}}