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Bupropion and nortriptyline (antidepressants) and varenicline and cytosine (nicotine receptor partial agonists) are cost-effective therapies in smoking cessation programs.

Measured by incremental cost-utility ratios (cost per quality adjusted life-year gained), bupropion was found to be more cost-effective than nicotine gum, when only the direct costs of the intervention were considered. If the effects of smoking cessation on production and consumption in the economy are also taken into account, bupropion is more cost-effective than both forms of NRT tested (nicotine patch and nicotine gum), at a relatively low incremental cost per quality-adjusted life-year gained. 

In the UK, the cost-effectiveness of bupropion for smoking cessation is better than many accepted healthcare interventions. The incremental cost per life year saved is about £640–1,500 (US$ 937 – 2,196) for bupropion and £900–2,000 (US$ 1,318 – 2,928) for NRT plus bupropion.

A meta-analysis comparing the cost-effectiveness of varenicline and bupropion found that varenicline is even more cost-effective.

Among the smoking cessation medications, cytisine and nortriptyline were found globabbly affordable based on World Health Organization criteria since their use can save a life-year for less than or equal to the per-capita gross domestic product in all countries worldwide.

Halpern M, Khan Z, Young T, Battista C. Economic model of sustained-release bupropion hydrochloride in health plan and work site smoking-cessation programs. Am J Health Syst Pharm. 2000; 57(15): 1421-1429

Javitz HS, Swan GE, Zbikowski SM, Curry SJ, McAfee TA, Decker DL, Patterson R, Jack LM. Cost-effectiveness of different combinations of bupropion SR dose and behavioral treatment for smoking cessation: A societal perspective. Am J Manag Care. 2004; 10: 217-226

Javitz HS, Swan GE, Zbikowski SM, Curry SJ, McAfee TA, Decker D, Patterson R, Jack LM. Return on investment of different combinations of bupropion SR dose and behavioral treatment for smoking cessation in a health care setting: an employer's perspective. Value Health. 2004; 7(5): 535-543.

Woolacott NF, Jones L, Forbes CA, Mather LC, Sowden AJ, Song FJ, Raftery JP, Aveyard PN, Hyde CJ, Barton PM. The clinical effectiveness and cost-effectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation. Health Technol Assess. 2002; 6(16): 1-245.

Mahmoudi M, Coleman CI, Sobieraj DM. Systematic review of the cost-effectiveness of varenicline vs. bupropion for smoking cessation. Int J Clin Pract. 2012 Feb;66(2):171-82.

West R, Raw M, McNeill A, Stead L, Aveyard P, Bitton J, Stapleton J, McRobbie H, Pokhrel S, Lester-George A, Borland R. Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction. 2015; 110: 1388-1403. logo
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