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Cytisine vs varenicline for smoking cessation in New Zealand

RAUORA Trial: Cytisine vs varenicline for smoking cessation in New Zealand

RAUORA Trial is a study evaluating whether cytisine, a nicotinic acetylcholine receptor partial agonist (like varenicline) found in some plants is effective, safe and cost-effective compared with varenicline for smoking cessation in Māori and the whānau (extended family) of Māori.

Dr Subhash Pokhrel from Health Economics Theme is leading the economics component of the RAUORA trial. New Zealand (NZ) has a smoke‐free 2025 goal (i.e. < 5% of adults smoking by 2025). To achieve this goal, net smoking cessation rates need to increase substantially, particularly for Māori who, in 2016, comprised 14% of the NZ population, who have a high prevalence of daily smoking (33%) compared with the general population (14%). Consequently, Māori has high rates of smoking‐related disease, contributing to the 7–8‐year life‐expectancy gap between Māori and non‐Māori in NZ. Offering cytisine may be a potentially cost-effective strategy in achieving this goal.

This is a pragmatic, community-based, open-label randomized non-inferiority trial based in the Lakes District Health Board region, NZ.


Cytisine versus varenicline for smoking cessation for Māori (the indigenous people of New Zealand) and their extended family: protocol for a randomized non‐inferiority trial

Meet the Principal Investigator(s) for the project

Professor Subhash Pokhrel - Subhash Pokhrel, PhD is a professor of public health economics. He is the Head of Department of Health Sciences and the Lead of the Health Economics Research Group (HERG). His work to date has largely been around supporting health systems to deliver efficient healthcare as well as strengthening health research systems to support more research into healthcare.    Subhash's research has contributed to several public health policies. The two REF2021 impact case studies - Supporting tobacco control decision making for improved health and economic productivity and Informaing policies and debates on breastfeeding promotion describe Subhash's approach to developing a programme of research and generate significant impact from them. His learning about how researchers can engage with and support goverments and wider stakeholders to make investment decisions in public health is underpinned by his and colleagues' earlier work around the suite of NICE Public Health ROI Tools. These ROI tools provided the basis for many public health investment decisions in England and were informed by the work on tobacco control led by Subhash. The ROI tools are practical, customisable models to help make real-world decisions in context of local, regional and national government decision-making. Economic arguments are needed to make the business case for public health investments. Subhash led the roll out of ROI work to several European nations through a €2 million multi-centre European Commission funded study, EQUIPT. He has been the coordinator of a large scale inter-disciplinary collaboration of national and international expertise. Subhash is the lead author of a book, ROI in Public Health Policy: Supporting Decision Making (Palgrave Macmillan). Subhash’s work in public health research has been as diverse as the discipline itself – from developing a household decision making pathway for child health care in low- and middle income countries (LMICs) to quantifying the economic impact of breastfeeding promotion in industrialised countries; from evaluating health insurance for its population health impact in LMICs to finding out what interventions could improve physical activity globally. Most recently, his doctoral researchers have investigated whether integrated care models, particularly in a local area in England, are effective; what determines obesity in West Africa and particularly the role of physical activity and dietary habits to reduce obesity among adults in Ghana; and what the correlates of COVID-19 hospitalisations and long-COVID in Ghana were. His visiting student from Sri Lanka has investigated the economics of physical activity in LMICs. Such research evidence, particularly in LMICs, is key to developing and evaluating public health measures for their value for money.   Subhash is intrigued not only by "health systems" questions (e.g. In LMICs and industrialised countries, what works to improve population health outcomes and at what cost?) but also by "health research systems" questions. Subhash worked with the WHO Euro to review the evidence on policies, interventions and tools for establishing and/or strengthening national health research systems and their effectiveness. In particular, Subhash and colleagues have investigated the extent of integration of research (particularly economic evaluations) into policymaking in Spain and what implications the Spanish experience could have globally for strenthening both systems. As a member of various external committees (NICE Technology Appraisal, NIHR PGfAHR and SPI-B), Subhash has contributed to decision making processes around funding of medical technologies, research in applied health, and behavioural measures to tackle public health emergencies.        Google Profile Orcid Profile ResearchGate BURA Profile

Related Research Group(s)


Health Economics (HERG) - Our strategic focus is on economic evaluation and systematic reviews of a broad range of clinical and health service technologies by providing high-quality, applied, policy-relevant research, as well as developing and refining methods to increase the rigour and relevance of such studies.

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Project last modified 20/10/2021