The National Service Framework (NSF) for coronary heart disease (CHD) is currently focusing on many strategies to reduce the prevalence of CHD in the UK population (Department of Health, 2000); these include blood pressure lowering, lipid lowering and smoking cessation. The aim of this study was to compare the cost-effectiveness of three smoking cessation agents with statins to prevent cardiovascular events over 1 year. We used data from the Health Survey for England 1998 as a representative sample of the English population (n = 19,654 aged 2 - 98) and identified all smokers with complete data aged 35-74 (n = 1410) - the target population of the NSF for CHD.

The Framingham risk equation was used to determine the 1-year CHD risk for primary prevention patients (Anderson et al., 1990) and the value used for those with cardiovascular disease (CVD) was based on their clinical history (Wood et al., 1998). Primary prevention patients were subdivided into low (0 to < 0.5%), intermediate (0.5 to < 1.5%) and high CHD risk ( 1.5%) cohorts. The CHD risk reduction with nicotine replacement therapy (NRT), bupropion and statins was estimated and used to predict the number of events saved and cost per event saved with each drug therapy. The average number of cigarettes smoked per day was used to determine the cost of smoking cessation therapy as recommended in the British National Formulary (BNF) 44. One-way and extreme scenario sensitivity analyses were performed (Briggs & Gray, 1999).

The mean age of the smoking population was 51.0 years, 46% were men, 1% had diabetes and 12% had existing CVD. The results of the analyses are shown in the table.

Table. Cost per event saved with NRT, bupropion and statins (£1000's).

Values are result ± 10% error; SPP = secondary prevention patients.

Our comparison suggests bupropion may be the most cost-effective drug therapy when following the advice in BNF 44, with NRT a close second. Nicotinell patches may be more cost-effective for secondary prevention patients who smoke more than 20 cigarettes per day. Statins are more expensive than bupropion and NRT, and should be considered for patients with CVD or at high CHD risk as recommended in current guidelines (Department of Health, 2000).

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