Does over-the-counter nicotine replacement therapy improve smokers' life expectancy?
William F Lawrencea, Stevens S Smithb, Timothy B Bakerb, Michael C Fioreb
a Cancer Clinical and Economic Outcomes Core,
Lombardi Cancer Center, Georgetown University Medical Center,
Washington, DC, USA, b Center for Tobacco
Research and Intervention, University of Wisconsin Medical School,
Madison, Wisconsin
Correspondence to: Dr WF Lawrence, Cancer Clinical and Economic Outcomes Core, Lombardi Cancer Center, 2233 Wisconsin Avenue, Suite 430, Washington, DC 20007, USA; lawrencw{at}gunet.georgetown.edu
OBJECTIVE
To determine the public health benefits
of making nicotine replacement therapy available without prescription,
in terms of number of quitters and life expectancy.
DESIGNA decision-analytic model was developed to
compare the policy of over-the-counter (OTC) availability of nicotine
replacement therapy with that of prescription (R) availability for
the adult smoking population in the United States.
MAIN OUTCOME MEASURESLong-term (six-month) quit
rates, life expectancy, and smoking attributable mortality (SAM) rates.
RESULTSOTC availability of nicotine replacement
therapy would result in 91 151 additional successful quitters over a
six-month period, and a cumulative total of approximately 1.7 million
additional quitters over 25 years. All-cause SAM would decrease by 348 deaths per year and 2940 deaths per year at six months and five years, respectively. Relative to R nicotine replacement therapy
availability, OTC availability would result in an average gain in life
expectancy across the entire adult smoking population of 0.196 years
per smoker. In sensitivity analyses, the benefits of OTC availability were evident across a wide range of changes in baseline parameters.
CONCLUSIONSCompared with R availability of
nicotine replacement therapy, OTC availability would result in more
successful quitters, fewer smoking-attributable deaths, and increased
life expectancy for current smokers.
Keywords: smoking cessation; nicotine replacement therapy; over-the-counter sales; decision analysis
© 1998 by Tobacco Control
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