Authors' recommendations: Given the available evidence, all pharmacotherapies under review are efficacious in helping the general population (relatively healthy smokers) quit smoking, with varenicline having a largereffect than bupropion and nicotine patch. From trials that met our selection criteria, adding behavioural support to drug therapy (i.e., drug plus or minus behavioural support versus drugalone) seems to have little impact on the overall success rates of the drugs. However, there was a trend in favour of adding drug to behavioural therapy compared with behavioural therapy alone.In specific populations, the evidence on clinical effectiveness of pharmacotherapies or combined therapies of drugs and behavioural support is mixed or limited. Considering the barriers to andinequalities in the availability of smoking cessation treatments, more research is needed in developing effective interventions for specific clinical populations. Cost is a barrier; full coverage may increase the use of these medications and have an impact on success rates. Health infrastructure improvements including a national cessation-education program for health care practitioners and the implementation and mandated delivery of smoking cessation programs in every health care setting are basic to ensuring that Canada and Canadians derive the benefits that can accrue from optimal rates of smoking cessation.For the general population, if a decision-maker’s threshold to pay for an additional QALY is at least $4,000 to $10,000 (depending on gender and age at the time of intervention), then varenicline would be the optimal therapy compared with bupropion, NRT (gum, inhaler, lozenge, and patch), or no treatment. Adding 10- to 15-minute counselling sessions to the nicotine patch therapy was not found to be cost-effective compared with the nicotine patch alone. If a drug plan’s threshold to pay for an additional QALY is at least $900, providing full reimbursement of NRTs (gum, patch, and inhaler) and bupropion would be cost-effective compared with no reimbursement for these drugs. For smoking cessation targeting those with cardiovascular or other smoking-related diseases, bupropion provided greater benefit with less cost over gum, inhaler, and/or patch. If, in this context, a drug plan’s threshold to pay for an additional QALY is at least $2,500, then bupropion would be the optimal choice compared with nicotine gum, inhaler, and/or patch and no intervention. For smoking cessation targeting hospitalized patients, bupropion would be the optimal choice among bupropion, nicotine patch, and no intervention if a decision-maker’s threshold to pay for an additional QALY is at least $3,000. The value of information analyses showed that further research to obtain more accurate estimates of clinical efficacy (i.e., quit rates), particularly for specific populations, would reduce decision uncertainty, hence providing the greatest information value to cost-effectiveness analyses. Following economic analysis results based on the general population, the potential budgetary impact of an increasing number of claims in varenicline would be between $158,000 and $21.5 million, and that of an increasing number of claims in varenicline and bupropion would be between $200,000 and $23.2 million, depending on jurisdictions.

Project Status: Completed

URL for project: https://cadth.ca/pharmacologic-based-strategies-smoking-cessation

Year Published: 2010

URL for published report: http://www.cadth.ca/media/pdf/H0486_Smoking_Cessation_tr_e.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: <p>Canadian Agency for Drugs and Technologies in Health (CADTH)</p>