Smoking cessation: prescribing nicotine patches in general practice was cost effective.

Clinical bottom line (level 1b)

  1. Prescribing nicotine patches in smokers was cost-effective.
  2. Prescribing nicotine patches in smokers aged 35 to 44 years old was most cost-effective, and prescribing them in smokers aged 55 to 65 years was least cost-effective.
Stapleton et al: Lancet 1999; 354: 210-215
Expires March 2003

The study


Setting: 30 general practice surgeries in 15 English counties

For intervention related cessation, a randomised, placebo controlled efficacy trial of nicotine patches, involving patients who smoker more than 14 cigarettes per day. For spontaneous cessation, national urvey data. For life years saved, Doll's 40yr prospective cohort study. For lieftime cessation, an estimate is used (uncertain provenance).

  • Viewpoint: National Health Service (NHS)
  • Benefit assessment: cost per life year saved
  • Resources and costs: Continued treatment in patients who do not abstain within the first week has been shown to be of no benefit, and so this was not carried out. The cost per patient treated with patches was calculated as the sum of the costs of counselling time, the cost of nicotine patches, the cost of the patients booklet on stopping smoking and the cost of biochemical validation abstinence. Cost per minute of GP time was GBP 1.77; the cost per minute of practice nurse time was GBP 0.43; cost of 1 weeks' nicotine patches to NHS (one box, one prescription) was GBP 9.07; pharmacy fee to NHS per prescription was GBP 0.94; cost of patient booklet was GBP 0.20; cost of biochemical validation of cessation was GBP 1.00.
  • Sensitivity analysis: One year treatment success rate varied by 20% was the main variable. 20% variation rates were also used for all the other components in the model.

    • The evidence

    intervention cost
    nicotine patches in smokers under 35 years GBP 397.95
    ( per life year saved )
    nicotine patches in 35 to 44 year olds GBP 344.68
    ( per life year saved )
    nicotine patches in 45 to 54 year olds GBP 432.32
    ( per life year saved )
    nicotine patches for 55 to 65 year olds GBP 785.43
    ( per life year saved )

    Effect of sensitivity analysis: The model was fairly robust to alterations, but lowering the 12 month success rate by 20% (which was an overestimate of sensitivity) would increase the cost to GBP 129 per life year saved.

    Comments

    1. Costs of offering an initial week of NRT to 'all comers' are not included in this analysis
    2. Data on lifetime smoking patterns are of uncertain quality, and taking the results of a single cessation RCT may be difficult to apply to the general population
    3. Study may underestimate benefits by not including morbidity costs

    Citation

    1. Stapleton JA, Lowin A, Russell MAH: Prescription of transdermal nicotine patches for smoking cessation in general practive: evaluation of cost-effectiveness. Lancet 1999; 354: 210-215
    Contributor: Clare Wotton and Musab Hayatli, January 2000
    Reviewer: Ross Lawrenson

    Clinical Question.
    Patient smokers
    Intervention or Exposure prescription nicotine patches
    Outcome cost effectiveness