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Miller et al present results from a workplace based smoking cessation study where 39% of nicotine replacement therapy (NRT) vouchers were redeemed for NRT patches for half the recommended retail price (RRP $US170, subsidised to US$85).1 However, the authors conclude that cost may not be a barrier to accessing NRT. The New Zealand experience shows that heavily subsidised NRT (92%) provided through an existing Quitline service considerably enhances access to NRT for smokers.
A nationwide programme to provide subsidised NRT was implemented from November 2000 through the New Zealand Quitline, a free telephone service for people wanting to quit smoking. Long term cessation rates have been found to improve when NRT is used as part of a behavioural intervention such as counselling.2,3
When smokers call the New Zealand Quitline they are assessed for their eligibility to receive vouchers for subsidised NRT (patches or gum). Eligibility criteria include being: a “heavier” smoker (10+ cigarettes/day); motivated to quit; and 18+ years of age. The subsidisation reduces the cost of NRT to the smoker from a maximum of NZ$199 (US$109) for eight weeks’ product to NZ$5 (US$2.70) for the first four weeks’ supply, and NZ$10 (US$5.40) for the second four weeks’ supply. This fee covers dispensing costs and provides a means of encouraging some degree of motivation to quit among smokers. Redeemed NRT vouchers are claimed by pharmacists through the Ministry of Health’s Health Payments, Agreements and Compliance Unit.
There was significant media interest as a result of the government coordinated NRT media release in November 2000 and the Quitline service was flooded with calls following the launch. Since this time calls have levelled to 9000 per month. Currently, around 41 000 smokers a year register with the Quitline to give up smoking and are issued with vouchers for NRT (from a national smoker population of 740 000). This is a large increase on the number of smokers accessing the Quitline only service before the introduction of the NRT voucher scheme.
Redemption analysis shows that 73% of vouchers issued through the Quitline are redeemed, considerably higher than that experienced by Miller et al1 (39%).4 Additional New Zealand research found that delivery of the voucher programme through the Quitline is enhancing access to NRT.5 A survey of Quitline callers who were positively assessed for NRT found that the process of receiving vouchers and redeeming these for nicotine patches and gum ran smoothly for respondents. Once respondents had the NRT, they were quick to start using it (80% started using their first four week supply within three days of receiving it) and they appeared to have a good understanding about how to use the patches and gum appropriately. Overall, there was little wastage of the nicotine patches and gum. Of those who redeemed their first voucher most (70%) reported using the whole four week course.
The enhancement of the New Zealand Quitline service through the provision of subsidised NRT has been viewed positively by smokers using the service and has greatly increased the number of people accessing the Quitline. Research results indicate that considerable subsidisation of NRT (92% in New Zealand’s case) as part of an enhanced Quitline counselling service indeed provides an incentive to smokers who want to quit.