Smoking and mental health - NCSCT

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Smoking and mental health 8.7 Harm reduction approaches Given the high rates of smoking and low rates of cessation in people with mental disorders to date, effective harm reduction strategies, such as providing safe medicinal nicotine products, have great potential as acceptable long-term or even lifelong substitutes for smoking. 50 We have estimated the order of magnitude of lifetime harm reduction in this population, using as examples the costs of two currently widely used nicotine replacement therapy (NRT) products, nicotine transdermal patches and nicotine inhalators. In so doing we have assumed an average cigarette consumption of 19 cigarettes/day among smokers with mental disorders, 51 and that to replace fully the 1 mg nicotine delivered to the circulation by each cigarette, 52 at 50% bioavailability, 53 40 mg NRT will be required each day. The average net ingredient cost for 40 mg NRT is approximately £3.00 for nicotine patches and £1.40 for inhalators. 26 As data comparing quality of life between long-term medicinal nicotine users and cigarette smokers are limited, 54 we have assumed that as tobacco smoke, rather than nicotine itself, is responsible for most of the adverse health effects of smoking, smokers who switch completely to using NRT products will get the same health benefits as those who quit all smoking and nicotine use. 55 Health benefits gained were measured using LYG and expected QALYs. 41 Both costs and health benefits were discounted at 3.5% per annum following NICE recommendations. 43 Table 8.10 presents the lifetime costs and health benefits of using nicotine patches and inhalators as substitutes for smoking, and the corresponding cost-effectiveness ratios for a number of different age ranges. Assuming that 2.5% of people who use NRT will quit all nicotine use entirely each year, the discounted lifetime cost was estimated as £16,711 per person for nicotine patches and £7,569 per person for inhalators (Table 8.10). If all current smokers with a mental disorder switched their smoking to NRT products immediately, over 1 million life-years will be gained for the group as a whole. The cost per LYG is £8,629 for nicotine patches and £3,908 for nicotine inhalators. The Cochrane review of NRT in smoking cessation shows discounted QALY gains for a successful lifetime quitter, compared with one who continues smoking, to be 2.22, 2.58, 2.14 and 0.99 for people who stop smoking at age 30, 40, 50 and 60, respectively. 56 In total, 1.1 million QALYs will be gained if 100% of the smokers using NRT products were to replace tobacco smoking with alternative forms of nicotine delivery immediately. Based on the above assumptions, a cost-effectiveness ratio of £7,956 per QALY gained for nicotine patches and £3,603 per QALY for inhalators has been estimated. These results indicate that substituting nicotine from smoking cigarettes with either nicotine patches or nicotine inhalators is a cost-effective strategy compared with continuing smoking, given willingness-to-pay thresholds of £20,000–£30,000 per additional QALY gained. 43 The earlier an individual substitutes smoking for a harm reduction alternative, the more cost-effective the strategy becomes. 176 © Royal College of Physicians 2013
The economic cost of smoking in people with mental disorders 8 Table 8.10 Lifetime cost and health benefits using harm reduction strategies Age group
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PDF not for circulation Smoking and
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Contents Members of the Tobacco Adv
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Contents 4.4.3 Attention deficit hy
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Contents 6.4.3 Staff knowledge 122
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Contents 10.5 Tobacco policy and me
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Contributors Anthony Aclet - Specia
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Contributors Jill Williams - Associ
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1 Mental disorders 1.1 What is a me
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Mental disorders 1 1.3 Common menta
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Mental disorders 1 1.4.4 Somatisati
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Mental disorders 1 In addition to s
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Mental disorders 1 not diagnosed un
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Mental disorders 1 Similar to many
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Mental disorders 1 12 Chang CK, Hay
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Mental disorders 1 52 Young S, Toon
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Smoking among people with mental di
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Neurobiological and behavioural mec
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Smoking cessation interventions for
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6 Population strategies to prevent
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Population strategies to prevent sm
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Smoking and mental health - NCSCT

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