Cost-Effectiveness Analysis of Smoking Cessation Interventions in the United Kingdom Accounting for Major Neuropsychiatric Adverse Events

ObjectivesSmoking is a leading cause of death worldwide. Cessation aids include varenicline, bupropion, nicotine replacement therapy (NRT), and e-cigarettes at various doses (low, standard and high) and used alone or in combination with each other. Previous cost-effectiveness analyses have not fully accounted for adverse effects nor compared all cessation aids. The objective was to determine the relative cost-effectiveness of cessation aids in the United Kingdom.MethodsAn established Markov cohort model was adapted to incorporate health outcomes and costs due to depression and self-harm associated with cessation aids, alongside other health events. Relative efficacy in terms of abstinence and major adverse neuropsychiatric events was informed by a systematic review and network meta-analysis. Base case results are reported for UK-licensed interventions only. Two sensitivity analyses are reported, one including unlicensed interventions and another comparing all cessation aids but removing the impact of depression and self-harm. The sensitivity of conclusions to model inputs was assessed by calculating the expected value of partial perfect information.ResultsWhen limited to UK-licensed interventions, varenicline standard-dose and NRT standard-dose were most cost-effective. Including unlicensed interventions, e-cigarette low-dose appeared most cost-effective followed by varenicline standard-dose + bupropion standard-dose combined. When the impact of depression and self-harm was excluded, varenicline standard-dose + NRT standard-dose was most cost-effective, followed by varenicline low-dose + NRT standard-dose.ConclusionAlthough found to be most cost-effective, combined therapy is currently unlicensed in the United Kingdom and the safety of e-cigarettes remains uncertain. The value-of-information analysis suggested researchers should continue to investigate the long-term effectiveness and safety outcomes of e-cigarettes in studies with active comparators.     

The effectiveness and efficiency of hygienists in carrying out orthodontic auxiliary procedures.

The aim of this study was to compare the ability and efficiency of dental hygienists, after preliminary training as orthodontic auxiliaries, with post-graduate orthodontists. The study was cross-sectional and prospective. The sample consisted of five second-year hygienists and five qualified orthodontists from Manchester University Dental Hospital. All subjects carried out a range of orthodontic exercises on phantom head typodonts. The ability and efficiency for each task was measured, and comparison made between hygienists and orthodontic groups. There was no statistically significant differences between hygienists and orthodontists in terms of their ability to carry out potential orthodontic auxiliary procedures. However, orthodontists were more efficient (P < 0.05). The ability of hygienists to carry out potential orthodontic auxiliary tasks after appropriate training is supported. Trained orthodontists are more efficient than newly trained hygienists in carrying out potential orthodontic auxiliary tasks.