Bupropion and Behavioral Treatment: An Employer's Perspective

Overview:

As shown in the 2003 study, "Effectiveness of Bupropion Sustained Release for Smoking Cessation in a Health Care Setting," telephone counseling in combination with bupropion is more effective at helping smokers quit than tailored self-help materials in combination with bupropion. Having identified Free & Clear plus bupropion as an effective program for smoking cessation, the researchers performed a financial analysis on the treatment to assess its return on investment (ROI) and its internal rate of return (IRR). Through the financial analysis, the researchers addressed employers' need to make cost-effective decisions when choosing smoking cessation programs for their employees.

Design:

The original trial divided 1,524 smokers into four treatment groups that varied on either dose of bupropion (150mg Zyban or 300mg Zyban) or type of smoking cessation program (Free & Clear or tailored self-help materials). The researchers used the baseline data shown in Table 1.0 to analyze the cost effectiveness of each of the four program combinations.

Table 1.0 Description of Data

DATA SOURCE VALUE Cost For Each Treatment Group (Based on direct + indirect costs of behavioral program and pharmacy overhead, pharmacy dispensing costs, and medication contract pricing) $195: Free & Clear + 150mg Zyban $283: Free & Clear + 300mg Zyban $119: Tailored materials + 150mg Zyban $207: Tailored materials + 300 mg Zyban Program Effectiveness (i.e. Quite Rate) (Based on percentage of people who quit smoking per group) 31.4%: Free & Clear + 150mg Zyban 33.2%: Free & Clear + 300mg Zyban 23.6%: Tailored materials + 150mg Zyban 25.7%: Tailored materials + 300 mg Zyban Benefit per Person Quit (Based on cumulative benefits over a five year period due to increased productivity, reduced absenteeism, and reduced medical expenditures related to tobacco-use) $3,745: 5-year benefit per 12-month quitter (accounting for 20% relapse rate among quitters)

 

Findings

Using the information in Table 1.0, the researchers calculated the return on investment (ROI) and internal return rate (IRR). Assessing each study group, they found the net benefit to the employer ranges from $343 to $569, with tailored self-help materials having considerably lower net benefits than the Free & Clear program. They also found no significant difference in benefit between the 150mg and 300mg Zyban doses. Therefore, on the basis of net benefit, Free & Clear plus Zyban is preferred to tailored self-help materials plus Zyban.

Return on Investment & Internal Return Rate -

In calculating the five-year ROI for the four programs, the researchers found positive ROIs ranging from a high of 297% (or a 32% annual IRR) in the tailored self-help materials plus 150mg Zyban to a low of 166% (or a 22% annual IRR) in the Free & Clear plus 300mg Zyban group. In general, programs with 150mg Zyban had the highest IRR, while programs with 300mg Zyban had the lowest IRR.

After determining the five-year ROI and IRR for the four program combinations using the study's observed quit rate (percentage of those who successfully quit smoking), the researchers recalculated the ROI and IRR based on pessimistic, observed, and optimistic quit rates, drawn from the range of quit rates established in the original study. The recalculations based on pessimistic, observed, and optimistic quit rates are shown in Table 2.0.

Table 2.0 Return on Investment based on Quit Rate Scenarios

F&C + 150mg Zyban ROI F&C + 300mg Zyban ROI Materials + 150mg Zyban ROI Materials + 300mg Zyban ROI Pessimistic Quit Rates 21.4% 13.9% 19.2% 10.1% Observed Quit Rates 29.2% 19.4% 29.7% 16.6% Optimistic Quit Rates 36.9% 24.9% 40.1% 23.1%

 

Conclusion:

This study examined ROI, IRR, and net benefits for four smoking cessation programs that varied on treatment intensity and Zyban dose. In this study, the Free & Clear plus 300mg Zyban program had a nearly optimal net benefit even though it was the most expensive treatment of the four treatment options. However, the tailored self-help materials plus 150mg dose of Zyban had the best ROI. Overall, ROI was very favorable for both Free & Clear and tailored self-help materials with a 150mg dose of Zyban, suggesting that following the manufacturers' standard recommendation of 300mg will result in a less cost-effective program for employers than one that uses 150mg Zyban plus Free & Clear or tailored self-help materials.

Employers seeking an optimal return on investment should select a smoking cessation program that features 150mg Zyban and Free & Clear or 150mg Zyban and tailored self-help materials.

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