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Prescribe smoking cessation drugs ‘for at least three months’

By Nigel Praities

Ex-smokers should be kept on medication for much longer to prevent them relapsing, concludes an NHS cost-effectiveness evaluation.

The systematic analysis of trials found the current system - where quitters were supported for four weeks should be extended – with medication prescribed for at least three months.

Currently stop smoking services are evaluated on the percentage of 4-week quitters, but around three-quarters relapse after this date.

The Health Technology Assessment found around 60% of services had some system of relapse prevention, but less than half of these used drug therapy with the rest using less evidence-based interventions, such as telephone follow-up or group therapy.

Pulse revealed earlier this year that the cost of stop smoking services had risen by 30% between 2007/08 to 2009/10 but quit rates had remained almost unchanged.

This new analysis estimates if stop smoking services were to use nicotine-replacement therapy, varenicline or bupropion drug therapy for over three months, they could potentially increase 12-monthly quit rates by between 10% to 20%.

Bupropion was the most cost-effective therapy, with relapse prevention saving an additional £86 and adding an additional QALY of 0.07.

Lead author Dr Tim Coleman, a smoking cessation researcher at the school of community health sciences, University of Nottingham and a GP in the city, said that using drug therapy for longer was cost effective as judged by the NICE £20,000 QALY threshold.

‘Guidance would be needed to encourage the adoption of the most effective relapse prevention interventions as would incentives that focussed on the importance of sustaining quit attempts beyond the currently monitored four-week targets,' he said.

Dr Alex Bobak, a GP in Wandsworth, south London and a smoking cessation adviser at his PCT, said he agreed with the assessment but warned that non-drug methods of support were just as important.

‘Personally I think support is key. There may be a bias towards pharmaceutical studies here and not enough on support for complying with therapy.

'If you take away the support in the medium or long-term, then you will grossly undermine the quit rates and you will increase the relapse rate,' he said.

Prescribe smoking cessation drugs 'for at least three months' Projected boosts to quit rate from relapse treatment

Bupropion +14%
Nicotine-replacement +13%
Varenicline +19%

Source: Coleman et al. Health Technology Assessment 2010; 14: 49


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