Prescribing nicotine replacement therapy to smokers trying to quit would be an efficient use of resources

Akehurst, R. L.

School of Health and Related Research; Sheffield, UK

Abstracted from:Stapleton JA, Lowin A, Russell MAH. Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness. The Lancet 1999; 354: 210-215 .

Evidence-based Healthcare 4(1):p 21, March 2000.

BACKGROUND

Smoking-related diseases account for almost 20% of mortality in more developed countries. There is strong evidence from previous studies that nicotine replacement therapy (NRT) is effective in helping smokers to stop. The 1998 UK government White Paper Smoking Kills emphasizes that in General Practice smokers should be offered advice and support in their efforts to quit. However, GPs are not allowed to write reimbursable prescriptions for NRT.

OBJECTIVE

To evaluate the cost per life year saved of prescribing NRT to smokers trying to quit.

SETTING

UK general practice.

METHOD

Cost-effectiveness analysis, based on a randomized placebo-controlled trial that compared 12 weeks of nicotine patches among heavy smokers (n = 1200) in 30 general practices across 15 English counties. National health service costs were derived from a survey accompanying the trial, and consisted of nicotine patches, counseling time and the biochemical validation of abstinence. The analysis assumed that only those who were abstinent from smoking at 1 week received continuing treatment. The probability of continuing relapse free, of unaided quitting, and of life years saved through quitting were selected from other trials and official figures. A sensitivity analysis was conducted on changes in these values. The discount rate was 1.75% (central estimate). No attempt was made to allow for different future medical costs between smokers and non-smokers.

LITERATURE REVIEW

No explicit strategy; 30 references.

OUTCOME MEASURES

Cost per life year saved.

RESULTS

TABLE

AUTHORS' CONCLUSIONS

This study is more robust than previous ones because it was conducted in a general practice setting and was based on a large efficacy trial that included direct resource-used measurement. This is shown to be a very efficient use of public resources, with cost per life years saved considerably lower than for most previously reported ratios for other treatments.