Smoking and mental health - NCSCT

The economic cost of smoking in people with mental disorders 8
8.4 Outpatient services and primary care
Outpatient and primary care use attributable to smoking in people with mental
disorders were estimated using generic NHS service use data, taking relative risk
estimates of service use in current and ex-smokers relative to non-smokers from
a recent study by Callum and colleagues, in turn based on data reported in the
2006 General Household Survey (GHS) 5 (Table 8.5).
Data on GP and practice nurse consultations were obtained from the
QResearch database, which estimates that the total number of consultations in
England in 2008 was 300.4 million, of which 62% and 34% respectively were
undertaken by GPs and nurses. 24 During 2010 an estimated £9bn was spent by
the NHS in England on prescription drugs in primary care, and 98% of these
drugs were prescribed by GPs. 25 In 2010 a total of 927 million prescription items
were dispensed, with an average net ingredient cost per prescription item of
£9.53. 26 Average costs for GP and nurse visits were sourced from the Personal
Social Services Research Unit (PSSRU) unit costs 2010, quantified at £32 per GP
consultation and £10 per practice nurse consultation. 27 As there are no direct
sources of data on the number of GP and practice nurse consultations and
prescriptions outside England, we used the data for England to extrapolate costs
for the UK, based on mid-2010 population estimates from the Office for
National Statistics (ONS). 28 Data on outpatient attendances were obtained from
HES data. 17 In 2009–10, the number of outpatient attendances for adults aged 35
and over was 27 million for males and 21 million for females. According to NHS
reference cost data, the average cost of an adult outpatient visit in 2009–10 was
£98. 22 Data for Wales, Scotland and Northern Ireland were obtained from the
Health and Care statistics on the Welsh government website, ISD of National
Services Scotland and NWIS websites respectively. 29–31
Table 8.6 lists the number of outpatient and primary care attendances and
prescriptions issued in primary care that are attributable to smoking among
Table 8.5 Relative risk (RR) estimates for outpatient and primary care
service use based on reports of health service use, General Household
Survey, 2006
Current smokers
Ex-smokers
RR 95% CI RR 95% CI
GP consultations 1.18 1.03–1.34 1.35 1.21–1.50
GP prescriptions 1.28 1.08–1.51 1.31 1.14–1.50
Practice nurse consultations 1.11 0.91–1.37 1.37 1.18–1.60
Outpatient attendances 1.05 0.88–1.24 1.17 1.01–1.37
CI, confidence interval.
Source: Callum et al., 2010. 5
© Royal College of Physicians 2013 169