A systematic review and meta-analysis found that the most effective smoking cessation approach was combining medicine therapies with varenicline. These findings were published in Health Technology Assessment.

Publication databases were searched by researchers from the University of Bristol in the United Kingdom through March 2017 and updated February 2019 for randomized clinical trials of smoking cessation lasting ≥6 months. A total of 363 trials with 201,045 participants were included. For the safety review, an additional 53 observational studies comprising 8,783,5403 participants were included.

Most monotherapies and combinatorial therapies were more effective than placebo at helping participants achieve sustained abstinence. The most effective treatments were varenicline standard plus nicotine replacement (odds ratio [OR], 3.22; 95% credible interval [CrI], 2.27-14.88), varenicline low plus nicotine replacement (OR, 5.70; 95% CrI, 1.57-21.12), and e-cigarette low (OR, 3.22; 95% CrI, 0.97-12.55).

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In addition to pharmacological approaches, participants who received counseling were more likely to achieve sustained abstinence (additional log-OR, 0.86; 95% CrI, 0.45-1.27).

Serious adverse events were associated with bupropion standard (OR, 1.27; 95% CrI, 1.04-1.58).

With a cost-effectiveness threshold of £20,000 (US$27,388/January 14, 2022) per quality-adjusted life-year, e-cigarette low was the most cost-effective (expected net benefit, £7085/US$9,701) followed by varenicline standard plus bupropion standard (expected net benefit, £6756/US$9,250) and varenicline standard plus nicotine replacement (expected net benefit, £6591/US$9,024). Including the effect of major adverse neuropsychiatric effects, varenicline standard plus nicotine replacement (expected net benefit, £9895/US$13,548) and varenicline low plus nicotine replacement (expected net benefit, £9759/US$13,359) were the most cost-effective strategies.

This study was limited by not including an assessment of bias.

These data indicated varenicline standard plus nicotine replacement was the most effective strategy for achieving sustained abstinence from smoking and was the most cost-effective strategy when accounting for major adverse neuropsychiatric effects. Additional counselling may improve the efficacy of smoking cessation strategies. The study authors noted that the varenicline standard is currently not licensed for use in the United Kingdom.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Thomas KH, Dalili MN, López-López JA, et al. Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis.Health Technol Assess. 2021;25(59). doi:10.3310/hta25590

This article originally appeared on Psychiatry Advisor