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Stop-smoking drug set to save £590m

A stop-smoking drug newly approved by NICE has the potential to save hundreds of millions of pounds of NHS cash, data considered by the institute suggests.

NICE concluded varenicline was more effective than NRT or bupropion and would bring substantial cost savings, after examining a detailed submission from manufacturer Pfizer.Savings were estimated at between £328m and £589m over the lifetime of the three million UK smokers prepared to quit.GPs have been warned to be prepared for 'a surge of interest' in the drug, which received approval in the institute's final appraisal determination last week, subject to appeal. Final guidance is expected in July to coincide with the smoking ban.NICE said varenicline should normally be prescribed alongside counselling and support but, in apparent recognition of shortages in smoking cessation services, agreed it could be offered alone if support was not available.Smoking experts said varenicline would not replace NRT or bupropion but gave GPs another choice of clinically proven treatment to offer smokers who wanted to quit.Trials have shown patients who took varenicline were 66% more likely to be non-smokers after a year than those who used NRT, and 58% more likely than those who took bupropion.Varenicline, a twice-daily pill, binds with nicotinic receptors in the brain, where it acts as a partial agonist and antagonist, alleviating symptoms of craving and reducing the rewards of smoking.Dr Paul Aveyard, a member of the NICE smoking cess-ation programme development group, said: 'Varenicline costs about the same as the other drugs and works better.'Dr Alex Bobak, a GP in Wandsworth, south London, and smoking cessation expert, said: 'This is a new kind of drug with a completely different mode of action. Not only does it stop patients wanting a cigarette, it means they don't get anything out of the cigarette.'Dr Bobak said a third of patients experienced nausea while taking the drug, but it was a 'self-limiting' side-effect. 'You can take it with food or water, and use a smaller dose at night if it is a problem,' he said.

NICE recommendations

• Evidence from direct trials and systematic reviews carried out by the manufacturer and expert review group demonstrated varenicline was superior to NRT and bupropion in achieving continuous abstinence• Varenicline is recommended in its licensed indications as an option for those who want to quit • Varenicline should normally be prescribed only as part of a programme of behavioural support

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