NICOTINE REPLACEMENT THERAPY

The clinical effectiveness and cost-effectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation

Background

The health hazards of smoking are significant and well established. Giving up smoking is difficult and therefore needs to be treated as a chronic, but potentially curable, illness. Nicotine replacement therapy (NRT) and bupropion sustained-release formulation (SR) (Zyban®) are two pharmacological agents available to aid smokers in their attempts to achieve smoking cessation. The aim of this review was to assess the clinical effectiveness, cost-effectiveness and adverse effects of bupropion SR and NRT for smoking cessation. The effects of therapy in assisting long-term reduction in the amount smoked by smokers who are unwilling or unable to quit were not assessed.

Findings

Both NRT and bupropion SR are effective interventions to assist smoking cessation. The relative effectiveness of bupropion SR and NRT still needs further research. Information on how to maximise effectiveness in practice is still lacking, but motivational support is probably involved. The most significant differences between NRT and bupropion SR relate to the adverse events and safety profiles of these interventions. Overall, the safety profile of NRT is more favourable, particularly given the small but real risk of seizure with bupropion SR. Irrespective of the methods used or the assumptions involved, the results of existing economic evaluations and the model developed in this review consistently suggest that smoking-cessation interventions, including the use of NRT and/or bupropion SR, are relatively cost-effective in terms of the cost per life-year saved. The worst-case scenarios still provide estimates of cost-effectiveness better than many other medical interventions.

Conducted by: NF Woolacott1, L Jones1, CA Forbes1, LC Mather1, AJ Sowden1, FJ Song2, JP Raftery2, PN Aveyard2, CJ Hyde2, PM Barton2

1. Centre for Reviews and Dissemination; 2. Department of Public Health & Epidemiology, University of Birmingham

Further details

Project page on HTA Programme website

Related guidance

Commissioned to inform NICE Technology Appraisal 39: The clinical effectiveness and cost effectiveness of bupropion (Zyban) and Nicotine Replacement Therapy for smoking cessation. London: National Institute for Clinical Excellence; 2002

Publications

Woolacott NF, Jones L, Forbes CA, Mather LC, Sowden AJ, Song FJ, Raftery JP, Aveyard PN, Hyde CJ, Barton PM. The clinical effectiveness and cost-effectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation. Health Technol Assess. 2002;6(16):1-245

Posters

Woolacott NF, Jones L, Mather LC , Forbes CA. Assessment of therapeutic safety in systematic reviews. International Society of Technology Assessment in Health Care Conference 2002. Berlin, Germany.

Funding

Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process