@article{6ee3a8319a5a4ca0a64ea006afd30735,
title = "A cost-effectiveness analysis of smoking cessation interventions in the UK accounting for major neuropsychiatric adverse events",
abstract = "Objectives: Smoking is a leading cause of death worldwide. Cessation aids include varenicline, bupropion, nicotine replacement therapy (NRT), and E-cigarettes at various doses and combined. Previous cost-effectiveness analyses have not fully accounted for adverse effects nor compared all cessation aids. The objective was to determine the relative cost-effectiveness of cessation aids in the UK.Methodology: An established Markov cohort model was adapted to incorporate health outcomes and costs due to depression and self-harm associated with cessation aids, alongside other health events. Relative efficacy in terms of abstinence and major adverse neuropsychiatric events was informed by asystematic review and network meta-analysis. Base case results are reported for UK-licenced interventions only. Two sensitivity analyses are reported, one including unlicenced interventions and another comparing all cessation aids but removing the impact of depression and self-harm. The sensitivity of conclusions to model inputs was assessed by calculating the expected value of partialperfect information.Results: When limited to UK-licenced interventions, varenicline standard-dose and NRT standard-dose were most cost-effective. Including unlicensed interventions, E-cigarette low-dose appeared most cost-effective followed by varenicline standard-dose + bupropion standard-dose combined. When the impact of depression and self-harm was excluded, varenicline standard-dose + NRT standard-dose was most cost-effective, followed by varenicline low-dose + NRT standard-dose.Conclusions: Although found to be most cost-effective, combined therapy is currently unlicensed in the UK and the safety of E-cigarettes remains uncertain. The value-of-information analysis suggested researchers should continue to investigate the long-term effectiveness and safety outcomes of E-cigarettes in studies with active comparators",
keywords = "cost-effectiveness, economic model, smoking cessation, value of information",
author = "Edna Keeney and Welton, {Nicky J} and Matt Stevenson and Dalili, {Michael N} and Lopez-Lopez, {Jose A} and Caldwell, {Deborah M} and Phillippo, {David M} and Munafo, {Marcus R} and Thomas, {Kyla H}",
year = "2020",
month = dec,
day = "5",
doi = "10.1016/j.jval.2020.12.012",
language = "English",
volume = "24",
pages = "780--788",
journal = "Value in Health",
issn = "1098-3015",
publisher = "Elsevier Inc.",
number = "6",
}