How do smoking cessation medicines compare with respect to their neuropsychiatric safety: a systematic review, network meta-analysis and cost effectiveness analysis.

Record ID 32016001079
Authors' objectives: Background to the research Cigarette smoking is one of the main causes of early death in the UK and worldwide. Each year, over 100,000 people die in the UK from smoking related diseases. National guidance published in 2008 recommends the use of three medicines, varenicline (Champix), bupropion (Zyban) and nicotine replacement therapy to help people quit smoking. However, since that guidance was first published there have been concerns about the safety of some of these medicines, especially varenicline. Some reports have suggested that smokers prescribed varenicline might be more likely than smokers prescribed other quit smoking medicines to experience mental health problems such as depression and suicidal thoughts. As a result, organisations which regulate medicines in the UK and the US have issued warnings about the safety of varenicline. Aims of the research In this study we will combine information from previous clinical trials to assess which quit smoking medicine is the safest and most effective. Design and Methods used: We will use special techniques which will allow us to make comparisons across all pairs of quit smoking medicines for example varenicline compared with bupropion, bupropion compared with NRT and varenicline compared with NRT; this improves on previous reviews which have mostly compared a particular quit smoking medicine with placebo (i.e. a sugar pill) when assessing safety and effectiveness of these medicines. We will also improve a previously published economic model by including side effects; this improved model will help us to determine which quit smoking medicine offers the best value for money for the NHS. We will determine whether this differs in different groups of smokers, including heavy smokers (i.e. people who smoke >20 cigarettes per day), people with mental illnesses and people with lung or heart disease. Patient and Public Involvement Members of a Smokers panel identified this research topic as high priority. These members also helped us in preparing this proposal and provided comments to improve this lay summary. We plan to involve members of this panel and members of the Public Advisory Group of the Elizabeth Blackwell Institute throughout the project. Dissemination This project s findings will be shared with the general public, healthcare practitioners and clinicians, local authority smoking cessation teams, academics (via peer reviewed publications and presentations at conferences), industry and policy makers including the Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE). This research will allow smokers who want to quit and their healthcare professionals (GPs, smoking cessation advisors) to make informed decisions about the risks and benefits of quit smoking medicines using the most up to date evidence available. Information on which quit smoking medicine is the best value for money will be of value to policy makers in the UK and people who commission services in the NHS.
Project Status: Ongoing
Anticipated Publish Date: 2021
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Bupropion
  • Cost-Benefit Analysis
  • Smoking Cessation
  • Drug Therapy
  • Nicotinic Agonists
  • Safety
  • Varenicline
  • Nicotine
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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