A recent article in the GP magazine Pulse All smokers should be put on varenicline, says QIPP analysis highlights research commissioned by NICE (National Institute for Health and Care Excellence) which suggests varenicline taken for 12 weeks after smoking cessation reduces relapse rates more than alternative medicines.
The Pulse article states:
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 article is based on a review carried out by Cochrane Collaboration. The review looked at 54 studies and compared varenicline, nicotine replacement, bupropion and behavioural therapy in preventing relapse. Research suggests that, despite the high cost of varenicline, it would be cost effective for it to be supplied through the NHS.
There is also huge variation in the efficiency of local services, with the cost per quitter in 2008/09 only £62 per quitter at NHS Gloucester, but £1,225 in Shetland. Smoking cessation experts said the rising cost reflected an overreliance on specialist services, at the expense of GP services.
Varenicline 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’.
The figures also come despite rising use of smoking cessation drugs in primary care. However in some areas GPs are being forced to send patients to their local pharmacy to get smoking cessation drugs.
Varenicline (Champix) is available to patients privately through UK regulated online clinics. Patients are often prepared to pay the high cost of treatment, which they may not be able to obtain from their GPs. Some high-street pharmacies also supply varenicline through private patient group directions. Again patients bear the cost.
NHS provision of smoking cessation is patchy and postcode dependent. Some areas offer repeat provisions of nicotine replacement, others do not. Support to quit in the form of behavioural counselling is sometimes available, although the Cochrane Collaboration analysis suggests a lack of good evidence for its efficacy.