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Systematic Review
This is a health technology assessment (HTA) of the clinical and cost-effectiveness of pharmaceutical and non-pharmaceutical smoking cessation products and services. It will provide the evidence to underpin a planned national clinical guideline on smoking cessation interventions and will inform policy decisions about potential improvements to the provision of smoking cessation services in the public health service.
In a general population of adult smokers, all pharmacological interventions were more effective than no treatment. Varenicline was the most effective monotherapy (RR 2.57, 95% CI: 2.32 – 2.85), and varenicline with NRT was the most effective dual therapy (RR 3.54, 95% CI: 2.57 – 4.61). The analysis of the effectiveness of behavioural therapies was complicated by considerable heterogeneity in how these interventions were defined.
All evaluated therapies were more effective than an alternative of ‘do nothing’. When compared with control, defined as brief advice or written materials, group behaviour therapy was the most effective behavioural intervention (RR 1.85, 95% CI: 1.53 – 2.23). The only statistically significant evidence of a beneficial treatment for people attending secondary care mental health services was bupropion when used as in addition to behavioural therapy and NRT in a population with schizophrenia or schizoaffective disorder (RR 3.86, 95% CI: 1.01 – 14.80). Among pregnant women there was some evidence of a beneficial effect with NRT, but this did not reach statistical significance (RR 1.41; 95% CI: 0.99 to 2.00).There was also evidence to suggest counselling, health education and financial incentives increase cessation rates in pregnant smokers.
A review of the safety profile of these interventions found that pharmacological therapies for smoking cessation are generally safe and well-tolerated in those for whom these treatments are not contraindicated. No substantive evidence of adverse events associated with behavioural interventions for smoking cessation was identified.
Quitting smoking is a complex, iterative process in which the choice of cessation intervention is only one of many factors that influence outcomes. However, there is good evidence that cessation rates can be improved if smokers choosing to make an assisted quit attempt are encouraged to use more effective interventions. A cost-effectiveness analysis of individual therapies found that while all included treatments were cost-effective compared with unassisted quitting, e-cigarettes and varenicline, alone or in combination with NRT, provide the best value for money on average.