This document was published more than 2 years ago. The nature of the evidence may have changed.
Bupropion (Zyban), the first drug registered for smoking cessation that does not contain nicotine, was introduced in Sweden during 2000. Originally, bupropion is an antidepressant. It is a prescription drug, but not covered under the drug benefit. The target group for treatment with bupropion includes smokers who have not succeeded with other treatment methods for smoking cessation.
The effects of bupropion, in combination with individual support, have been studied in several randomized, placebo-controlled studies. Compiling the results from the two most important studies, where followup was conducted after 1 year, shows that the rate of continually smoke-free individuals was 19% in the group that received bupropion and 9% in the placebo group. This means that ten individuals must be treated with bupropion for one person to become smoke-free. Bupropion caused moderate side effects such as mouth dryness and insomnia in a small number of study participants, and in rare cases study subjects were affected by seizures.
Currently, no studies have investigated the cost-effectiveness of bupropion treatment in Sweden. The cost for the drug alone is approximately 1000 SEK per treatment cycle. In addition, the costs for physician time correspond to at least one physician visit in primary care and a varying number of other contacts with physicians or nurses for followup and support. Economic analysis based on simulation models suggests that future savings in healthcare costs to a large extent would offset the cost of treatment for smoking cessation [6,16]. A model analysis from Great Britain indicates that the average cost per life-year saved is reasonably low. The cost per QALY of adding bupropion to counselling is approximately 12 500–27 500 SEK.
The scientific evidence on the effects of bupropion, along with individual followup support in smoking cessation, is good*. However, knowledge about the cost-effectiveness of the method is poor*. Until further notice, bupropion should be considered second line treatment because of the serious, but rare, side effects.
*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.
This summary is based on a report prepared at SBU in collaboration with Assoc. Prof. Peter Nilsson, Malmö University Hospital and has been reviewed by Agneta Hjalmarson, Lic. Psychol., Sahlgrenska University Hospital and Bertil Johnsson, MD, Medical Products Agency.
The complete report is available in Swedish only.
Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.
presents a comprehensive, systematic assessment of available scientific evidence. The certainty of the evidence for each finding is systematically reviewed and graded. Full assessments include economic, social, and ethical impact analyses.
SBU assessments are performed by a team of leading professional practitioners and academics, patient/user representatives and SBU staff. Prior to approval and publication, assessments are reviewed by independent experts, SBU’s Scientific Advisory Committees and Board of Directors.