School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
Addiction. 2024 Jul;119(7):1188-1202. doi: 10.1111/add.16464. Epub 2024 Mar 22.
To conduct a systematic review and meta-analysis and pool the incremental net benefits (INBs) of varenicline compared with behaviour support with bupropion or nicotine replacement therapy (NRT), behaviour support alone and unaided cessation in adult smokers making a first-time attempt to quit.
A search for economic evaluation studies was conducted from inception to 30 September 2022, on PubMed, Embase, Cost-Effectiveness Analysis (CEA) Registry by Tufts Medical Centre, EconLit and the NHS Economic Evaluation Database (NHS EED). Eligible studies were included if they were (1) conducted among adults ages 18 years old and older who were smokers attempting to quit for the first time; (2) compared varenicline to behaviour support with bupropion or NRT, behaviour support alone and unaided cessation; and (3) performed a CEA or cost-utility analysis. The INBs were calculated and pooled across studies stratified by country income level and study perspective using the random-effects model. Statistical heterogeneity between studies was assessed using the I statistic and Cochrane Q statistic.
Of the 1433 identified studies, 18 studies were included in our review. Our findings from healthcare system/payer perspective suggested that the use of varenicline is statistically significantly cost-effective compared with bupropion (pooled INB, $830.75 [95% confidence interval, $208.23, $1453.28]), NRTs ($636.16 [$192.48, $1079.84]) and unaided cessation ($4212.35 [$1755.79, $6668.92]) in high-income countries. Similarly, varenicline is also found to be cost-effective compared to bupropion ($2706.27 [$1284.44, $4128.11]), NRTs ($3310.01 [$1781.53, $4838.50]) and behavioural support alone ($5438.22 [$4105.99, $6770.46]) in low- and middle-income countries.
Varenicline is cost-effective as a smoking cessation aid when compared with behavioural support with bupropion or nicotine replacement therapies and behavioural support alone in both high-income countries and low- and middle-income countries, from the healthcare system/payer perspective in adult smokers who attempt to quit for the first time.
进行系统评价和荟萃分析，并汇总伐伦克林与行为支持加安非他酮或尼古丁替代疗法（NRT）、单独行为支持和未辅助戒烟相比，在首次尝试戒烟的成年吸烟者中的增量净效益（INB）。
从 2022 年 9 月 30 日起，在 PubMed、Embase、塔夫茨医疗中心成本效益分析（CEA）登记处、EconLit 和英国国家卫生服务经济评估数据库（NHS EED）上对经济评估研究进行了检索。如果研究符合以下条件，则被纳入：（1）在年龄为 18 岁及以上、首次尝试戒烟的吸烟者中进行；（2）比较伐伦克林与行为支持加安非他酮或 NRT、单独行为支持和未辅助戒烟；（3）进行成本效益分析或成本效用分析。使用随机效应模型，根据国家收入水平和研究视角对研究进行分层，计算并汇总 INB。使用 I 统计量和 Cochrane Q 统计量评估研究之间的统计学异质性。
在 1433 项已确定的研究中，有 18 项研究纳入了我们的综述。从医疗保健系统/支付者的角度来看，我们的研究结果表明，与安非他酮（汇总 INB，$830.75 [95%置信区间，$208.23，$1453.28]）、NRT（$636.16 [192.48，$1079.84]）和未辅助戒烟（$4212.35 [1755.79，$6668.92]）相比，伐伦克林的使用在高收入国家具有统计学意义上的成本效益。同样，与安非他酮（$2706.27 [1284.44，$4128.11]）、NRT（$3310.01 [1781.53，$4838.50]）和单独行为支持（$5438.22 [4105.99，$6770.46]）相比，伐伦克林在低收入和中等收入国家也被认为是一种具有成本效益的戒烟辅助手段。
从医疗保健系统/支付者的角度来看，在首次尝试戒烟的成年吸烟者中，伐伦克林与行为支持加安非他酮或尼古丁替代疗法和单独行为支持相比，在高收入国家和低收入及中等收入国家均具有成本效益。
