Smoking and mental health - NCSCT

The economic cost of smoking in people with mental disorders 8
olanzapine (£27m) and duloxetine (£3m), although the availability since 2011
of non-proprietary olanzapine at a cost of around 30% of the proprietary
form 34 would reduce the potential savings, if all prescribed olanzapine were
non-proprietary, to £9m.
8.6 Life-years gained from smoking cessation in mental
disorders
Smoking cessation substantially increases life expectancy. Half of smokers die
prematurely, unless they quit, 35 and quitting smoking at age 30, 40, 50 or 60
years gains, respectively, about 10, 9, 6 and 3 years of additional life expectancy. 36
Recent data from the NHS Health and Social Care Information Centre (HSCIC)
indicate that mortality in people with serious mental disorder is three times the
population average. 37
Taking data from the Adult Psychiatric Morbidity Survey (APMS) in England, 38
in combination with mid-2009 UK population estimates published by the Office
for National Statistics 39 and smoking prevalence by mental health diagnosis from
Table 2.3 (see Chapter 2), we have estimated the numbers of smokers with these
mental disorders, by age, in the UK (Table 8.8).
As the majority of people with mental disorders are diagnosed by their mid-
20s, 40 their life-years gained (LYG) by stopping smoking can be assumed to be
the same as for the general population. Table 8.8 shows estimated LYG by
smoking cessation for individuals with mental disorders by age, with discounting
to reflect individuals’ and society’s time preference 41,42 at 3.5% per annum, in
line with the methods of technology appraisal recommended by the National
Institute for Health and Clinical Excellence (NICE). 43
Table 8.9 presents the estimated LYG for a range of smoking cessation rates
among people with mental health diagnoses in the UK. Achieving cessation in
25%, 50% or 100% of people with mental disorders will result in a gain of 5.5
million, 11 million and 22 million undiscounted life-years, respectively. The
corresponding discounted LYG figures, at a 3.5% discount rate, are 1.4, 2.7 and
5.4 million.
Smoking cessation is one of the most cost-effective lifesaving public
health or medical interventions. 44–48 When only comparing the costs of an
intervention with no intervention, the estimated incremental cost per
quality-adjusted life-year (QALY) gained varies from around £221 to around
£9,515. 49 Even if we assume that the effectiveness of smoking cessation
interventions for people with mental health disorders is only half that
observed in the general population, smoking cessation is still highly costeffective
when compared with the NICE willingness-to-pay threshold of
£20,000–£30,000 per QALY. 43
© Royal College of Physicians 2013 173