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OBJECTIVES: Smoking 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.METHODS: An 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.RESULTS: When 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.CONCLUSION: Although 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.

Background The co-location of expertise in public health, social care, and place services in local authorities facilitates tackling the wider determinants of health using transdisciplinary approaches. Local authority research systems are needed to enable local authorities to become research active, co-produce research, evaluate their impact, and produce and use evidence to shape practice and policy at pace. We aimed to explore and recommend what is necessary for a South Gloucestershire Council (SGC) research system to sustainably produce impactful research activity. Methods We did qualitative interviews with elected members and senior leadership of SGC and key stakeholders from local National Institute for Health Research (NIHR) infrastructure and organisations identified by expert sampling. Interviews were semi-structured with tailored topic guides exploring several topics, including relationships between SGC and local partners, resource and support, co-production, social care research, and the impact of COVID-19. Data from interviews were electronically transcribed verbatim using Otter.ai and coded using NVivo qualitative data analysis software. Data were analysed using the framework method and recommendations were proposed based on the findings. Ethical approval was granted by the University of Bristol's Faculty of Health Science Research Ethics Committee. Findings We interviewed 27 participants (five from SGC, 22 from local research organisations). Participants identified a need for a SGC research lead to facilitate collaboration and relationship building, and more joint posts across the local authority and external organisations. There was a need for collaborative cross-boundary working, as SGC works with other local authorities in their Sustainability and Transformation Partnership and Clinical Commissioning Group. Challenges included difficulties identifying SGC's priorities and population needs, data, staff training, and collaboration with academic researchers. They also reported resource issues exacerbated by COVID-19. Participants did not express conflicting views on these findings. Interpretation We recommended the creation of a local authority research lead post working across Council directorates, local authority research networks, support for joint posts, increased accessibility and use of local authority data, cross-boundary research systems, and infrastructure to support research to respond to local authority needs. We also suggested increased funding and incentivisation for academics to engage with local authority research. Potential barriers to these recommendations include local authority funding and staff capacity challenges. This study was limited by its recruitment method, sample size, and data collection and analyses completed by a single researcher. Future research should explore what types of evidence local authorities consider most relevant and useful. Funding NIHR Public Health Research (grant number NIHR131952).