Background:
Over 50% of tobacco users want to quit. Smoking cessation is beneficial both for preventing tobacco-attributable diseases and for making their treatment more effective. There is a variety of effective and scientifically proven smoking cessation aids. Cytisine, a partial nicotine agonist, is the oldest smoking cessation tool widely used mainly in countries of Central and Eastern Europe, but the interest in its use is currently on the rise also in Western Europe and other countries.

Objective:
Review recent studies and briefly conclude on cytisine’s safety, efficacy, and cost-effectiveness in smoking cessation.

Material and Methods:
This is a brief narrative review of recent clinical and pharmacoeconomic studies, mainly their systematic and narrative reviews, meta-analyses, and randomized clinical trials on cytisine as a smoking cessation aid. The publications were searched on PubMed, Medline, EMBASE, Cochrane Library, and Worldwide Science.

Results:
The summary of clinical studies shows that cytisine may mostly contribute to increasing moderate gastrointestinal adverse events when compared to placebo and nicotine replacement therapy (NRT). In comparison with varenicline, cytisine-based treatment of nicotine addiction has fewer adverse effects. The efficacy of cytisine as a smoking cessation aid is well-documented in clinical trials. For the primary outcome and longer abstinence, cytisine is more efficient than placebo and NRT but has less efficacy than varenicline. When compared with other smoking cessation aids, the cost of a standard 25-day treatment of nicotine dependence by cytisine is a few times cheaper and significantly more cost-effective.

Conclusions:
Cytisine is a safe, efficient, cheap, and cost-effective smoking cessation aid as compared with placebo and NRT. Although cytisine seems less clinically effective than varenicline, its use is much cheaper and more cost-effective than varenicline. However, there is an urgent need to design and conduct an international multi-center head-to-head double-blind clinical trial of cytisine and varenicline to evaluate the efficacy and cost-effectiveness of these two medicines sufficiently. Nevertheless, we currently have enough scientific evidence to recommend cytisine as an essential smoking cessation aid, incorporate it into guidelines for smoking cessation, use it in routine medical practice when treating nicotine addiction, and globally promote it, especially in developing countries and in lower social strata.