ArticlesPrescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness
Introduction
The enormous toll of cigarette smoking on public health has been known for many years. Smoking-related diseases account for almost 20% of mortality in more developed countries.1 Individuals who smoke throughout their lives have a 50% risk of dying prematurely and have a life expectancy that is 8 years less than those who have never smoked.2 Because the number of people smoking has stopped declining in the past few years and uptake of smoking among young people has remained fairly constant,3 there is an urgent need for effective interventions to encourage cessation
The financial burden on health-service resources in the treatment of smoking-related diseases is about £1·7 billion every year in the UK.4 Despite overwhelming evidence that nicotine-replacement therapy (NRT) is effective in helping smokers to stop,5 general practitioners (GPs) cannot give a National-Health-Service (NHS) prescription for NRT, only a private one. In the White Paper on smoking, Smoking Kills, the UK government proposed a limited correction to this anomaly.6 The report acknowledges that smoking is highly addictive, and that about 70% of smokers want to give up but seem unable to do so despite repeated attempts. The White Paper offers “real support from the NHS to help smokers quit”. Support comes through promotion of new specialist smoking-cessation services, which are allowed to provide free NRT to those exempt NHS prescription charges for only 1 week, within a fixed budget of just over £60 million for 3 years. By any standards this intervention is a modest start at tackling such a major and, until now, largely neglected health issue. We aimed to estimate the cost-effectiveness of extending this treatment into general practice and allowing GPs to continue prescribing NRT for up to 12 weeks, if the treatment is proving successful.
In our placebo-controlled trial of 1200 heavy smokers in 30 general practices we previously showed that the 16 h transdermal nicotine patch doubled the 1-year sustained-success rate achieved by brief GP counselling alone.7, 8 Another large trial showed a 24 h nicotine patch to be similarly effective in this setting.9 As part of our trial, a survey of participating GPs was done to assess the health-care resources used in treatment. From these data, and data from other reported sources, we have estimated the incremental cost-effectiveness of patch treatment—ie, the extra cost required to save each extra life year, over the option of brief GP counselling alone, assuming the costs are met by the NHS.
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The treatment and resource use trial
Heavy smokers have a high risk of developing a smoking-related illness10 and are more highly dependent on nicotine and hence less successful at stopping without help than people who smoke less.8 The specific aim of our previous trial was to target more dependent smokers (smoking more than 14 cigarettes per day) who were motivated to stop, and selection for inclusion was based on responses to a short screening questionnaire and the judgment of the GPs. Our criteria for selection based on the
Results
The incremental cost-effectiveness ratios for the NHS treating a new patient at various ages with the nicotine patches are shown in table 3. The difference in cost-effectiveness for those treated at different ages reflects the competing effects of LYS, discounting, lifetime unaided quitting, and differing NHS prescription exemption rates. The balance of these factors suggest that the intervention would be marginally more cost-effective in individuals aged 35–44 years. The treatment is less
Discussion
Previous studies have assessed the cost-effectiveness of nicotine-patch treatment but this study is different in that it was done in a general-practice setting and was based on a large efficacy trial that also incorporated a direct assessment of the health-care resources used. The results show that GP intervention with the nicotine patch would be very cost-effective if funded by the NHS. Even allowing for the differing method used to assess the cost-effectiveness of other treatments, the
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A Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update. A U.S. Public Health Service Report
2008, American Journal of Preventive MedicineCitation Excerpt :Cost effectiveness can be measured in a variety of ways, including cost per quality-adjusted-life-year saved (QALY); cost per quit; healthcare costs and utilization pre- and post-quit; and return on investment (ROI) for coverage of tobacco-dependence treatment. Numerous analyses have estimated the cost per QALY saved resulting from use of effective tobacco-dependence interventions.99,127–134 In general, evidence-based tobacco-use interventions compare quite favorably with other prevention and chronic disease interventions such as treatment of hypertension and mammography screening when using this criterion.
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2010, ThoraxCitation Excerpt :Results for the cost-effectiveness of pharmacotherapy and intensive counselling in COPD were comparable with the cost per QALY gained for smoking cessation support in the general population. For the general population studies on NRT, bupropion and nortriptyline have shown cost-effectiveness ratios consistently below €10 000 per (quality adjusted) life year.12 35–38 The cost-effectiveness ratio for minimal counselling in COPD is somewhat higher than in studies in the general public.11 12
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