Smoking and mental health - NCSCT

Smoking and mental health
Chapter 5) and hence generate cost savings. Table 8.7 lists a selection of
psychotropic drugs affected by smoking in this way, together with the best-case,
maximum percentage dose reduction needed with smoking cessation, as taken
from the Maudsley prescribing guidelines. 32
For patients prescribed one or more psychoactive medications, drug
prescriptions to smokers and non-smokers in 1 year were derived from the
THIN (The Health Improvement Network) dataset (see Chapter 2), and unit
costs for each drug by different dose forms and strength sourced from NHS
prescription costs. 33 Cost savings from stopping smoking were then calculated
by multiplying the percentage dose reduction by the dose used in smokers, and
corresponding unit costs. In total, quitting smoking among people with mental
health disorders has the potential to save the NHS £40m per year in
psychotropic medicine costs. The greatest cost savings are from proprietary
Table 8.7 Drug cost saving from reduced doses by stopping smoking
Drug Best-case percentage Smoking Cost saving
dose reduction with prevalence
smoking cessation (%)
Clozapine 50 51.5 £136,000
Duloxetine 50 32.5 £3,314,000
Fluphenazine 50 40.3 £106,000
Fluvoxamine 33 28.7 £43,000
Haloperidol 20 25.5 £865,000
Olanzapine 50 40.7 £26,710,000
Anxiolytic benzodiazepines
Diazepam 50 29.4 £1,926,000
Alprazolam 50 22.8 £13,000
Chlordiazepoxide 50 52.4 £286,000
Oxazepam 50 27.7 £329,000
Lorazepam 50 22.7 £1,244,000
Tricyclic antidepressants
Amitriptyline 50 22.5 £2,395,000
Clomipramine 50 26.9 £534,000
Dosulepin 50 24.3 £651,000
Doxepin 50 19.8 £58,000
Imipramine 50 20.8 £114,000
Lofepramine 50 28.2 £529,000
Nortriptyline 50 19.7 £391,000
Trimipramine 50 20.3 £239,000
Total cost saving £39,882,000
172 © Royal College of Physicians 2013