A cost-effectiveness analysis of smoking cessation interventions in the UK accounting for major neuropsychiatric adverse events

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 a
systematic 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 partial
perfect 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