human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVES To evaluate the cost-effectiveness of an additional 12-week treatment with varenicline for abstainers who had successfully completed an initial 12-week treatment . DESIGN The Benefits of Smoking Cessation on Outcomes simulation model was used to simulate both direct and indirect effects of smoking cessation . All calculations were performed in 2003 Swedish prices . SETTING Sweden in 2003 . PATIENTS OR PARTICIPANTS The modelled cohort consisted of 25 % of adult smokers motivated to quit smoking ( 168,844 males and 208,737 females ) . The age and sex distributions of the cohort reflect that of the Swedish population in 2003 . INTERVENTIONS Smokers who had achieved abstinence for at least 7 days following 12-week open-label treatment with varenicline were r and omized to receive an additional 12-week treatment with either varenicline or placebo . MEASUREMENTS AND RESULTS The incremental costs per quality -adjusted life-year ( QALY ) gained , for abstainers who received an additional 12-week varenicline treatment compared with only 12 weeks , were Euro 7066 for men and Euro 7108 for women , over a 50-year time horizon . ( 1 Euro approximately equal to SEK 9.12 ) . These estimates excluded indirect effects on production and consumption of increased survival . The corresponding incremental costs per QALY including indirect effects were Euro 24,149 and Euro 24,436 , respectively . Sensitivity analysis indicated that the estimated cost-utility ratios are robust , but relatively sensitive to treatment efficiency and intervention costs . CONCLUSIONS An additional 12-week course of varenicline treatment , provided to abstainers after an initial 12-week treatment , produces relatively low incremental cost-utility ratios in the spectrum of life-saving medical treatments Background Smoking is the leading cause of preventable death in the US . While one in five individuals smoke , and 70 % of these indicate a desire to quit , < 5 % of unaided quit attempts succeed . Cessation aids can double or triple the odds of successfully quitting . Models of smoking-cessation behaviour can eluci date the implication s of individual abstinence patterns to allow better tailoring of quit attempts to an individual ’s characteristics . Objective The objectives of this study were to develop and vali date a discrete-event simulation ( DES ) to evaluate the benefits of smoking abstinence using data from the pooled pivotal clinical trials of varenicline versus bupropion or placebo for smoking cessation and to provide a foundation for the development of a lifetime smoking-cessation model . Methods The DES model simulated the outcome of a single smoking-cessation attempt over 1 year , in accordance with the clinical trial timeframes . Pharmaceutical costs were assessed from the perspective of a healthcare payer . The model r and omly sample d patient profiles from the pooled varenicline clinical trials . All patients were physically and mentally healthy adult smokers who were motivated to quit abruptly . The model allowed for comparisons of up to five distinct treatment approaches for smoking cessation . In the current analyses , three interventions corresponding to the clinical trials were evaluated , which included brief counselling plus varenicline 1.0 mg twice daily ( bid ) or bupropion SR 150 mg bid versus placebo ( i.e. brief counselling only ) . The treatment periods in the clinical trials were 12 weeks ( target quit date : day 8) , with a 40-week non-treatment follow-up , and counselling continuing over the entire 52-week period in all treatment groups . The main outcome modelled was the continuous abstinence rate ( CAR ; defined as complete abstinence from smoking and confirmed by exhaled carbon monoxide ≤10 ppm ) at end of treatment ( weeks 9–12 ) and long-term follow-up ( weeks 9–52 ) , and total time abstinent from smoking over the course of 52 weeks . The model also evaluated costs and cost-effectiveness outcomes . Results For the varenicline , bupropion and placebo cohorts , respectively , the model predicted CARs for weeks 9–12 of 44.3 % , 30.4 % and 18.6 % compared with observed rates of 44.0 % , 29.7 % and 17.7 % ; over weeks 9–52 , predicted CARs in the model compared with observed rates in the pooled clinical studies were 22.9 % , 16.4 % and 9.4 % versus 22.4 % , 15.4 % and 9.3 % , respectively . Total mean abstinence times accrued in the model varenicline , bupropion and placebo groups , respectively , were 3.6 , 2.6 and 1.5 months and total pharmaceutical treatment costs were $ US261 , $ US442 and $ US0 ( year 2008 values ) over the 1-year model period . Using cost per abstinent-month achieved as a measure of cost effectiveness , varenicline dominated bupropion and yielded an incremental cost-effectiveness ratio of $ US124 compared with placebo . Conclusion The model accurately replicated abstinence patterns observed in the clinical trial data using individualized predictions and indicated that varenicline was more effective and may be less costly than bupropion . This simulation incorporated individual predictions of abstinence and relapse , and provides a framework for lifetime modelling that considers multiple quit attempts over time in diverse patient population s using a variety of quit attempt strategies The cost-effectiveness of  smoking cessation interventions is well documented . However , most studies are based on r and omized controlled trials ( RCTs ) and provide little information on the differences between subgroups . This study assessed the relative cost-effectiveness of smoking cessation interventions  offered to various subgroups of smokers , based on real-life data . Regression analyses provided information on the factors determining abstinence and costs and led to the formation of relevant subgroups of smokers . Probabilistic Markov modeling was then used to estimate the relative cost-effectiveness of smoking cessation interventions  for the entire data base population and for the subgroups compared to a no-intervention case . The ICER for the base case population was estimated at € 1,358 . This is consistent with results from the existing literature . Group simulations showed lower ICERs for men , hospitals , and light smokers and falling ICERs with increasing age . Despite differences in the cost-effectiveness ratios between subgroups our results do not justify any kind of subgroup differentiation in a smoking prevention policy BACKGROUND The aim of this study was to evaluate and compare the cost-effectiveness of varenicline with nicotine replacement therapy ( NRT ) for smoking cessation in four European countries ( Belgium , France , Sweden and the UK ) . METHODS Markov simulations , using the Benefits of Smoking Cessation on Outcomes ( BENESCO ) model , were performed . We simulated the incidence of four smoking-related morbidities : lung cancer , chronic obstructive pulmonary disease , coronary heart disease and stroke . The model computes quality -adjusted life-years gained and incremental cost-effectiveness ratios . Incremental cost-utility ratios were calculated , adopting a lifetime perspective . Efficacy data were obtained from a r and omized open-label trial : Week 52 continuous abstinence rates were 26.1 % for varenicline and 20.3 % for NRT . RESULTS The analyses imply that for countries analysed , smoking cessation using varenicline versus NRT was associated with reduced smoking-related morbidity and mortality . The number of morbidities avoided , per 1000 smokers attempting to quit , ranged from 9.7 in Belgium to 6.5 in the UK . The number of quality -adjusted life-years gained , per 1000 smokers , was 23 ( Belgium ) ; 19.5 ( France ) ; 29.9 ( Sweden ) ; and 23.7 ( UK ) . In all base-case simulations ( except France ) , varenicline dominated ( more effective and cost saving ) NRT regarding costs per quality -adjusted life-year gained ; for France the incremental cost-effectiveness ratio was 2803 . CONCLUSION This cost-effectiveness analysis demonstrated that since varenicline treatment was more effective , the result was increased healthcare cost savings in Belgium , Sweden and the UK . Our results suggest that funding varenicline as a smoking cessation aid is justifiable from a healthcare re source allocation perspective Introduction : An employer-based cost-benefit analysis for varenicline versus bupropion was conducted using clinical outcomes from a recently published trial . Methods : A decision tree model was developed based on the net benefit of treatment to produce a nonsmoker at 1 year . Sensitivity analyses were conducted based on quit rates with placebo and varenicline and the cost of varenicline . Results : Estimated 12-month employer cost savings per non-smoking employee were $ 540.60 for varenicline , $ 269.80 for bupropion SR generic , $ 150.80 for bupropion SR br and , and $ 81.80 for placebo . Varenicline was more cost beneficial  than placebo , which had quit rates of 16.9 % or less . The quit rate  with varenicline would have to be ≤16.9 % to lose cost benefit over bupropion SR generic . Conclusions : The economic benefit  of varenicline is improved over bupropion , despite the increased initial cost of varenicline Background  Physician training in smoking cessation counseling  has been shown to be effective as a means to increase quit success . We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme . Its effectiveness was previously demonstrated in a cluster r and omized , control trial performed in two Swiss university out patients clinics , in which residents were r and omized to receive training in smoking interventions or a control educational intervention .  Design and methods We used a Markov simulation model for effectiveness analysis . This model incorporates the intervention efficacy , the natural quit rate , and the lifetime probability of relapse after 1-year abstinence . We used previously published results in addition to hospital service and outpatient clinic cost data . The time horizon was 1 year , and we opted for a third-party payer perspective . Results The incremental cost of the intervention amounted to US$ 2.58 per consultation by a smoker , translating into a cost per life-year saved of US$ 25.4 for men and 35.2 for women . One-way sensitivity analyses yielded a range of US$ 4.0 - 107.1 in men and US$ 9.7 - 148.6 in women . Variations in the quit rate of the control intervention , the length of training effectiveness , and the discount rate yielded moderately large effects on the outcome . Variations in the natural cessation rate , the lifetime probability of relapse , the cost of physician training , the counseling time , the cost per hour of physician time , and the cost of the booklets had little effect on the cost-effectiveness ratio . Conclusions Training residents in smoking cessation counseling  is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions Abstract Objectives : To conduct a cost-utility analysis of two 12-week  smoking-cessation interventions in Japan :  smoking-cessation counselling by a physician compared with use of varenicline , an oral smoking-cessation drug , in addition to counselling . Methods : A Markov model was constructed to analyse lifetimemedical costs and QALYs from the perspective of the healthcare payer . The cycle length was 5 years . Both costs and QALYs were discounted at 3 % annually . The cohort of smokers was classified by sex and age , and we assumed that smokers started smoking at the age of 20 years and received smoking-cessation therapy at the ages of 30 , 40 , 50 , 60 or 70 years ( five separate models were run ) . The healthcare costs and QALYs were calculated throughout the term until the age of 90 years . In the base-case analysis , success rates of varenicline plus counselling and counselling alone were assumed to be 37.9 % and 25.5 % , respectively , in male smokers , and 22.2 % and 16.1 % , respectively , in female smokers , based on a r and omized controlled trial conducted in Japan . Both univariate and probabilistic sensitivity analyses were conducted . Results : Prescribed varenicline was shown to be more effective and less costly than smoking-cessation counselling alone . Varenicline would save direct medical costs of Japanese Yen (¥)43 846 ( $ US381 ; $ US1= ¥ 115 ; Oct 2007 ) and generate an increase of 0.094 QALYs in male smokers . In females the incremental costeffectiveness ratio was ¥ 346 143 per QALY gained . Varenicline is estimated to save ¥ 23.7 billion ( $ US206 million ) of the medical costs for tobacco-associated diseases for the whole population . Overall savings are ¥ 9.5 billion . Sensitivity analyses suggested the robustness of the results . Conclusion : As with any data of this nature , there is some uncertainty in the results and further research is warranted . However , based on the results of this pharmacoeconomic evaluation , varenicline , the first non-nicotine , oral treatment developed for smoking cessation , appears to be cost effective and may contribute to future medical cost savings in Japan BACKGROUND The 1998 UK government White Paper Smoking Kills emphasises that normal practice should be for general practitioners ( GPs ) , practice nurses , and others to offer advice and support to smokers in their efforts to stop . However , GPs are not allowed to write NHS prescriptions for nicotine 
    Output:
    
agent
All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVES To evaluate the cost-effectiveness of an additional 12-week treatment with varenicline for abstainers who had successfully completed an initial 12-week treatment . DESIGN The Benefits of Smoking Cessation on Outcomes simulation model was used to simulate both direct and indirect effects of smoking cessation . All calculations were performed in 2003 Swedish prices . SETTING Sweden in 2003 . PATIENTS OR PARTICIPANTS The modelled cohort consisted of 25 % of adult smokers motivated to quit smoking ( 168,844 males and 208,737 females ) . The age and sex distributions of the cohort reflect that of the Swedish population in 2003 . INTERVENTIONS Smokers who had achieved abstinence for at least 7 days following 12-week open-label treatment with varenicline were r and omized to receive an additional 12-week treatment with either varenicline or placebo . MEASUREMENTS AND RESULTS The incremental costs per quality -adjusted life-year ( QALY ) gained , for abstainers who received an additional 12-week varenicline treatment compared with only 12 weeks , were Euro 7066 for men and Euro 7108 for women , over a 50-year time horizon . ( 1 Euro approximately equal to SEK 9.12 ) . These estimates excluded indirect effects on production and consumption of increased survival . The corresponding incremental costs per QALY including indirect effects were Euro 24,149 and Euro 24,436 , respectively . Sensitivity analysis indicated that the estimated cost-utility ratios are robust , but relatively sensitive to treatment efficiency and intervention costs . CONCLUSIONS An additional 12-week course of varenicline treatment , provided to abstainers after an initial 12-week treatment , produces relatively low incremental cost-utility ratios in the spectrum of life-saving medical treatments Background Smoking is the leading cause of preventable death in the US . While one in five individuals smoke , and 70 % of these indicate a desire to quit , < 5 % of unaided quit attempts succeed . Cessation aids can double or triple the odds of successfully quitting . Models of smoking-cessation behaviour can eluci date the implication s of individual abstinence patterns to allow better tailoring of quit attempts to an individual ’s characteristics . Objective The objectives of this study were to develop and vali date a discrete-event simulation ( DES ) to evaluate the benefits of smoking abstinence using data from the pooled pivotal clinical trials of varenicline versus bupropion or placebo for smoking cessation and to provide a foundation for the development of a lifetime smoking-cessation model . Methods The DES model simulated the outcome of a single smoking-cessation attempt over 1 year , in accordance with the clinical trial timeframes . Pharmaceutical costs were assessed from the perspective of a healthcare payer . The model r and omly sample d patient profiles from the pooled varenicline clinical trials . All patients were physically and mentally healthy adult smokers who were motivated to quit abruptly . The model allowed for comparisons of up to five distinct treatment approaches for smoking cessation . In the current analyses , three interventions corresponding to the clinical trials were evaluated , which included brief counselling plus varenicline 1.0 mg twice daily ( bid ) or bupropion SR 150 mg bid versus placebo ( i.e. brief counselling only ) . The treatment periods in the clinical trials were 12 weeks ( target quit date : day 8) , with a 40-week non-treatment follow-up , and counselling continuing over the entire 52-week period in all treatment groups . The main outcome modelled was the continuous abstinence rate ( CAR ; defined as complete abstinence from smoking and confirmed by exhaled carbon monoxide ≤10 ppm ) at end of treatment ( weeks 9–12 ) and long-term follow-up ( weeks 9–52 ) , and total time abstinent from smoking over the course of 52 weeks . The model also evaluated costs and cost-effectiveness outcomes . Results For the varenicline , bupropion and placebo cohorts , respectively , the model predicted CARs for weeks 9–12 of 44.3 % , 30.4 % and 18.6 % compared with observed rates of 44.0 % , 29.7 % and 17.7 % ; over weeks 9–52 , predicted CARs in the model compared with observed rates in the pooled clinical studies were 22.9 % , 16.4 % and 9.4 % versus 22.4 % , 15.4 % and 9.3 % , respectively . Total mean abstinence times accrued in the model varenicline , bupropion and placebo groups , respectively , were 3.6 , 2.6 and 1.5 months and total pharmaceutical treatment costs were $ US261 , $ US442 and $ US0 ( year 2008 values ) over the 1-year model period . Using cost per abstinent-month achieved as a measure of cost effectiveness , varenicline dominated bupropion and yielded an incremental cost-effectiveness ratio of $ US124 compared with placebo . Conclusion The model accurately replicated abstinence patterns observed in the clinical trial data using individualized predictions and indicated that varenicline was more effective and may be less costly than bupropion . This simulation incorporated individual predictions of abstinence and relapse , and provides a framework for lifetime modelling that considers multiple quit attempts over time in diverse patient population s using a variety of quit attempt strategies The cost-effectiveness of  smoking cessation interventions is well documented . However , most studies are based on r and omized controlled trials ( RCTs ) and provide little information on the differences between subgroups . This study assessed the relative cost-effectiveness of smoking cessation interventions  offered to various subgroups of smokers , based on real-life data . Regression analyses provided information on the factors determining abstinence and costs and led to the formation of relevant subgroups of smokers . Probabilistic Markov modeling was then used to estimate the relative cost-effectiveness of smoking cessation interventions  for the entire data base population and for the subgroups compared to a no-intervention case . The ICER for the base case population was estimated at € 1,358 . This is consistent with results from the existing literature . Group simulations showed lower ICERs for men , hospitals , and light smokers and falling ICERs with increasing age . Despite differences in the cost-effectiveness ratios between subgroups our results do not justify any kind of subgroup differentiation in a smoking prevention policy BACKGROUND The aim of this study was to evaluate and compare the cost-effectiveness of varenicline with nicotine replacement therapy ( NRT ) for smoking cessation in four European countries ( Belgium , France , Sweden and the UK ) . METHODS Markov simulations , using the Benefits of Smoking Cessation on Outcomes ( BENESCO ) model , were performed . We simulated the incidence of four smoking-related morbidities : lung cancer , chronic obstructive pulmonary disease , coronary heart disease and stroke . The model computes quality -adjusted life-years gained and incremental cost-effectiveness ratios . Incremental cost-utility ratios were calculated , adopting a lifetime perspective . Efficacy data were obtained from a r and omized open-label trial : Week 52 continuous abstinence rates were 26.1 % for varenicline and 20.3 % for NRT . RESULTS The analyses imply that for countries analysed , smoking cessation using varenicline versus NRT was associated with reduced smoking-related morbidity and mortality . The number of morbidities avoided , per 1000 smokers attempting to quit , ranged from 9.7 in Belgium to 6.5 in the UK . The number of quality -adjusted life-years gained , per 1000 smokers , was 23 ( Belgium ) ; 19.5 ( France ) ; 29.9 ( Sweden ) ; and 23.7 ( UK ) . In all base-case simulations ( except France ) , varenicline dominated ( more effective and cost saving ) NRT regarding costs per quality -adjusted life-year gained ; for France the incremental cost-effectiveness ratio was 2803 . CONCLUSION This cost-effectiveness analysis demonstrated that since varenicline treatment was more effective , the result was increased healthcare cost savings in Belgium , Sweden and the UK . Our results suggest that funding varenicline as a smoking cessation aid is justifiable from a healthcare re source allocation perspective Introduction : An employer-based cost-benefit analysis for varenicline versus bupropion was conducted using clinical outcomes from a recently published trial . Methods : A decision tree model was developed based on the net benefit of treatment to produce a nonsmoker at 1 year . Sensitivity analyses were conducted based on quit rates with placebo and varenicline and the cost of varenicline . Results : Estimated 12-month employer cost savings per non-smoking employee were $ 540.60 for varenicline , $ 269.80 for bupropion SR generic , $ 150.80 for bupropion SR br and , and $ 81.80 for placebo . Varenicline was more cost beneficial  than placebo , which had quit rates of 16.9 % or less . The quit rate  with varenicline would have to be ≤16.9 % to lose cost benefit over bupropion SR generic . Conclusions : The economic benefit  of varenicline is improved over bupropion , despite the increased initial cost of varenicline Background  Physician training in smoking cessation counseling  has been shown to be effective as a means to increase quit success . We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme . Its effectiveness was previously demonstrated in a cluster r and omized , control trial performed in two Swiss university out patients clinics , in which residents were r and omized to receive training in smoking interventions or a control educational intervention .  Design and methods We used a Markov simulation model for effectiveness analysis . This model incorporates the intervention efficacy , the natural quit rate , and the lifetime probability of relapse after 1-year abstinence . We used previously published results in addition to hospital service and outpatient clinic cost data . The time horizon was 1 year , and we opted for a third-party payer perspective . Results The incremental cost of the intervention amounted to US$ 2.58 per consultation by a smoker , translating into a cost per life-year saved of US$ 25.4 for men and 35.2 for women . One-way sensitivity analyses yielded a range of US$ 4.0 - 107.1 in men and US$ 9.7 - 148.6 in women . Variations in the quit rate of the control intervention , the length of training effectiveness , and the discount rate yielded moderately large effects on the outcome . Variations in the natural cessation rate , the lifetime probability of relapse , the cost of physician training , the counseling time , the cost per hour of physician time , and the cost of the booklets had little effect on the cost-effectiveness ratio . Conclusions Training residents in smoking cessation counseling  is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions Abstract Objectives : To conduct a cost-utility analysis of two 12-week  smoking-cessation interventions in Japan :  smoking-cessation counselling by a physician compared with use of varenicline , an oral smoking-cessation drug , in addition to counselling . Methods : A Markov model was constructed to analyse lifetimemedical costs and QALYs from the perspective of the healthcare payer . The cycle length was 5 years . Both costs and QALYs were discounted at 3 % annually . The cohort of smokers was classified by sex and age , and we assumed that smokers started smoking at the age of 20 years and received smoking-cessation therapy at the ages of 30 , 40 , 50 , 60 or 70 years ( five separate models were run ) . The healthcare costs and QALYs were calculated throughout the term until the age of 90 years . In the base-case analysis , success rates of varenicline plus counselling and counselling alone were assumed to be 37.9 % and 25.5 % , respectively , in male smokers , and 22.2 % and 16.1 % , respectively , in female smokers , based on a r and omized controlled trial conducted in Japan . Both univariate and probabilistic sensitivity analyses were conducted . Results : Prescribed varenicline was shown to be more effective and less costly than smoking-cessation counselling alone . Varenicline would save direct medical costs of Japanese Yen (¥)43 846 ( $ US381 ; $ US1= ¥ 115 ; Oct 2007 ) and generate an increase of 0.094 QALYs in male smokers . In females the incremental costeffectiveness ratio was ¥ 346 143 per QALY gained . Varenicline is estimated to save ¥ 23.7 billion ( $ US206 million ) of the medical costs for tobacco-associated diseases for the whole population . Overall savings are ¥ 9.5 billion . Sensitivity analyses suggested the robustness of the results . Conclusion : As with any data of this nature , there is some uncertainty in the results and further research is warranted . However , based on the results of this pharmacoeconomic evaluation , varenicline , the first non-nicotine , oral treatment developed for smoking cessation , appears to be cost effective and may contribute to future medical cost savings in Japan BACKGROUND The 1998 UK government White Paper Smoking Kills emphasises that normal practice should be for general practitioners ( GPs ) , practice nurses , and others to offer advice and support to smokers in their efforts to stop . However , GPs are not allowed to write NHS prescriptions for nicotine 
    Output:
    