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All smokers should be put on varenicline, says QIPP analysis

GPs should either initiate or switch patients to varenicline after 12-weeks to prevent relapse, a QIPP analysis by the Cochrane Collaboration has concluded.

The analysis – part of a series of cost-effectiveness reviews commissioned by NICE – found despite it being the most expensive smoking cessation therapy, only varenicline showed any benefit in preventing relapse among smokers.

The controversial finding contradicts a Health Technology Assessment  carried out last year which found that bupropion was the most cost-effective therapy, with relapse prevention adding an additional QALY of 0.07.

The Cochrane analysis of 54 studies concluded there was little evidence of any benefit from behavioural interventions and little to support the use of bupropion or nicotine replacement therapies past the recommended duration for smoking cessation.

Varenicline costs costs £163.80 for a 12-week course, and the Cochrane review said that if all patients prescribed bupropion - estimated at a maximum of 41,000 - as well as those on other non-beneficial relapse prevention strategies were switched to varenicline, there would be a ‘cost implication in the short term'.

But it went on to conclude: ‘This cost will be offset in the long-term by the overall cost of treating smoking-related diseases in the 7% of abstainers who would otherwise relapse'.

However Dr Tim Coleman, a smoking cessation researcher at the School of Community Health Sciences, University of Nottingham and a GP in the city, said the review on which the QIPP analysis was based had been taken into account last year in the HTA, of which he was lead author.

He said: ‘We felt there was evidence of benefit for bupropion and for nicotine replacement therapy which is what most people use for quitting and is much cheaper.'

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