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(HTA) of Smoking Cessation Interventions

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(HTA) of Smoking Cessation Interventions Health technology assessment (HTA) of smoking cessation interventions 22 March 2017 1 Health Technology Assessment (HTA) of smoking cessation interventions Health Information and Quality Authority 2 Health Technology Assessment (HTA) of smoking cessation interventions Health Information and Quality Authority About the Health Information and Quality Authority The Health Information and Quality Authority (HIQA) is an independent authority established to drive high quality and safe care for people using our health and social care services in Ireland. HIQA’s role is to develop standards, inspect and review health and social care services and support informed decisions on how services are delivered. HIQA aims to safeguard people and improve the safety and quality of health and social care services across its full range of functions. HIQA’s mandate to date extends across a specified range of public, private and voluntary sector services. Reporting to the Minister for Health and engaging with the Minister for Children and Youth Affairs, HIQA has statutory responsibility for: . Setting Standards for Health and Social Services – Developing person-centred standards, based on evidence and best international practice, for health and social care services in Ireland. Regulation – Registering and inspecting designated centres. Monitoring Children’s Services – Monitoring and inspecting children’s social services. Monitoring Healthcare Safety and Quality – Monitoring the safety and quality of health services and investigating as necessary serious concerns about the health and welfare of people who use these services. Health Technology Assessment – Providing advice that enables the best outcome for people who use our health service and the best use of resources by evaluating the clinical effectiveness and cost-effectiveness of drugs, equipment, diagnostic techniques and health promotion and protection activities. Health Information – Advising on the efficient and secure collection and sharing of health information, setting standards, evaluating information resources and publishing information about the delivery and performance of Ireland’s health and social care service. 3 Health Technology Assessment (HTA) of smoking cessation interventions Health Information and Quality Authority Foreword Given the higher risk of disease and death in smokers, the economic cost of smoking in Ireland is substantial. In 2013, the estimated cost to the healthcare system was over €460 million, the cost of lost productivity was over €1 billion, and the cost of loss of welfare was over €9 billion. Smoking cessation substantially reduces the risk of developing most smoking-related diseases and also reduces the risk of death. A diverse range of smoking cessation interventions and services are currently funded by the public health system in Ireland. To consolidate activity in this area and to maximise the clinical benefits, an evidence-based analysis of the clinical and cost- effectiveness of the existing smoking cessation treatments was deemed necessary. The National Tobacco Control Advisor to the Department of Health requested that the Health Information and Quality Authority (HIQA) undertake a health technology assessment (HTA) of the clinical and cost-effectiveness of pharmaceutical and non-pharmaceutical smoking cessation products and services. This request followed a recommendation in the national strategy ‘Tobacco Free Ireland’ to examine the national and international evidence on the effects of the use of nicotine replacement therapy and other interventions that support smokers to quit smoking. This HTA will provide the evidence to underpin a planned national clinical guideline on smoking cessation interventions and will inform policy decisions about potential improvements to the provision of smoking cessation services in the public health service. Work on the assessment was undertaken by an Evaluation Team from the HTA Directorate in HIQA. A multidisciplinary Expert Advisory Group was convened to advise HIQA during the course of the assessment. A public consultation was carried out to get feedback from interested parties before finalising the report. HIQA would like to thank its Evaluation Team, the members of the Expert Advisory Group and all who contributed to the public consultation and the preparation of this report. Dr Máirín Ryan, Deputy Chief Executive and Director of Health Technology Assessment, Health Information and Quality Authority 4 Health Technology Assessment (HTA) of smoking cessation interventions Health Information and Quality Authority Table of Contents About the Health Information and Quality Authority .................................. 3 Foreword ....................................................................................................... 4 Table of Contents .......................................................................................... 5 Acknowledgements ...................................................................................... 7 List of abbreviations used in this report..................................................... 10 Advice to the Minister for Health ................................................................ 11 Executive Summary .................................................................................... 15 Plain language summary ............................................................................ 31 1 Introduction ............................................................................................. 33 1.1 Background to the request ............................................................................ 33 1.2 Terms of Reference ...................................................................................... 34 1.3 Overall approach .......................................................................................... 35 1.4 Public consultation ....................................................................................... 36 2 Description of the technology ................................................................. 38 2.1 Smoking cessation interventions .................................................................... 38 2.2 Discussion.................................................................................................... 53 2.3 Key points ................................................................................................... 55 3 Epidemiology ........................................................................................... 56 3.1 Effects of smoking........................................................................................ 56 3.2 Health outcomes associated with smoking ..................................................... 64 3.3 Smoking behaviour in Ireland ....................................................................... 69 3.4 Smoking cessation ....................................................................................... 76 3.5 Discussion ................................................................................................... 87 3.6 Key messages .............................................................................................. 89 4 Clinical effectiveness ............................................................................... 91 4.1 Methods ...................................................................................................... 91 4.2 Clinical effectiveness in unselected adults ...................................................... 99 4.3 Clinical effectiveness in users of secondary mental health services ................ 149 4.4 Clinical effectiveness in women during pregnancy ........................................ 164 4.5 Discussion.................................................................................................. 180 5 Health Technology Assessment (HTA) of smoking cessation interventions Health Information and Quality Authority 4.6 Key points .................................................................................................. 183 5 Safety ..................................................................................................... 185 5.1 Introduction ............................................................................................... 185 5.2 Nicotine replacement therapy (NRT) ............................................................ 185 5.3 E-cigarettes ............................................................................................... 189 5.4 Varenicline ................................................................................................. 196 5.5 Bupropion .................................................................................................. 199 5.6 Safety in pregnancy .................................................................................... 203 5.7 Safety in mental health populations ............................................................. 207 5.8 Safety in adolescents .................................................................................. 216 5.9 Discussion.................................................................................................. 217 5.10 Key points ................................................................................................ 217 6 Economic analysis .................................................................................. 220 6.1 Review of cost-effectiveness studies ............................................................ 220 6.2 Economic analysis
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