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EDITORIALS: Martin Raw, Ann McNeill, Judith Watt, and David Raw National smoking cessation services at risk BMJ 2001; 323: 1140-1141 [Full text]

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Smoking Cessation Services: Top Return On Investment

Jonathan Foulds   (17 November 2001)

Smoking cessation works

Gurmukh Singh Kalsi   (19 November 2001)

Enormous potential of smoking cessation

Kevin Lewis   (29 November 2001)

Smoking Cessation Services: Top Return On Investment 17 November 2001
Jonathan Foulds, Associate Professor University of Medicine and Dentistry of New Jersey - School of Public Health, NJ 08901 Send response to journal: Re: Smoking Cessation Services: Top Return On Investment	Dear colleagues, Raw and colleagues (1) are correct to state that many around the world have been watching the UK's smoking cessation services with admiration. We have seen clear evidence from research trials showing that tobacco dependence treatment works and is highly cost-effective, but the UK is the first country in the world to try implement treatment services on a nationwide scale. Some might have queeried whether sufficient numbers would attend these new services, and whether the success rates would be comparable to those achieved in the research centers. 127,000 making a quit attempt and 48% achieving short-term abstinence is indeed a remarakable achievement in one year. The resultant cost of less than 800 GBPounds per life-year-saved represents excellent value for money by any standards (2). In the United States, where much healthcare is paid for by private health insurance, those organisations also look for a positive return on their investment in paying for services. That is, they look for cost-savings later for dollars invested in treatment now. It has become clear that treating tobacco dependence produces a strong positive return on investment, by reducing substantially the high costs of treating myocardial infarctions, cancers premature births and chronic respiratory diseases caused by smoking (3). Health insurance companies in US states such as Utah, California and Minnesota have realised that treatments with a high positive return on investment should receive increased investment and are now expanding coverage (payment) for effective behavioral and pharmacological treatment services similar to those in the UK (4). These calculations do not include numerous other positive effects of effective smoking cessation services, such as those on time off work for employees or the number of young people taking up smoking partly by copying their parents. For the UK National Health Service to set up such an exemplarary service and then allow it to wither and die by not continuing its funding would be truly scandalous. Now that the initial "pilot" funding has been so successful and has shown such a good return on investment, the minister for health should act now to secure INCREASED funding for these services in the long term. 1. Raw M, Mcneill A, Watt J, Raw D. National smoking cessation services at risk. BMJ 2001;323:1140-1 2. Stapleton J. Cost effectiveness of NHS smoking cessation services. August 2001. www.ash.org.uk/html/cessation/ashcost.html 3. Health Risks and Their Impact On Medical Costs. Milman & Robertson, Brookfield, WI, 1995. 4. Harris J, Schauffler HH, Milstein A, Powers P, Hopkins DP. Expanding health insurance coverage for smoking cessation treatments:experience of the Pacific Business Group on Health. Am J Health Prom 2001;15:350-356
Smoking cessation works 19 November 2001
Gurmukh Singh Kalsi, Specialist Registrar in Public Health Medicine North Derbyshire Health Authority, Scarsdale, Newbold Road, Chesterfield, S41 7PF Send response to journal: Re: Smoking cessation works	Smoking cessation works EDITOR - We agree with Raw et al (1) that ringfenced funding for NHS smoking cessation services should continue beyond March 2002 and believe that Primary Care Trusts (PCTs) should be charged with the responsibility of ensuring that their smokers have access to this type of service. It would be unethical if the NHS failed to provide such a service that has been shown to be clinically- and cost-effective. In North Derbyshire, smoking is the most important public health problem. Nearly 30% of our local residents smoke. It is a major cause of preventable death and disability locally. Launched in October 2000, the North Derbyshire Stop Smoking Service (2) provides smokers with access to a range of services. These include the NHS Smoking Helpline, Nicotine Replacement Therapy (NRT) and smoking cessation aids on prescription, one-to-one counselling and advice and group support. Our local service has already seen approximately 1,000 smokers and 60% setting a quit date had achieved their goal at 4 weeks follow-up from completion of their cessation course. The service has exceeded the national average of 48% in helping people to stop smoking at one month follow-up. We plan to undertake further evaluation of the local service and would like to know as soon as possible if specific funding for smoking cessation services will be available as from April next year. We strongly believe that discontinuation of smoking cessation services would be a major backward step for the government, the NHS and public health. Consequently, we have expressed our concerns to local Members of Parliament in writing and urge our colleagues elsewhere to take similar action. 1. Raw M, McNeill A, Watt J, Raw D. National smoking cessation services at risk. BMJ 2001;323:1140-1. 2. North Derbyshire Health Authority. North Derbyshire Stop Smoking Service. http://www.northderbyshirehealth.nhs.uk/HTipExpand.asp?htipid=10 (accessed 19 November 2001). Dr Gurmukh Singh Kalsi Specialist Registrar in Public Health Medicine North Derbyshire Health Authority kalsigs@yahoo.co.uk Dr Gerald Beales Director of Health Promotion North Derbyshire Health Authority Dr Carol Singleton Director of Health Policy and Public Health North Derbyshire Health Authority, Scarsdale, Newbold Road, Chesterfield S41 7PF
Enormous potential of smoking cessation 29 November 2001
Kevin Lewis, Clinical Director of Smoking Cessation Shropshire Health Authority Send response to journal: Re: Enormous potential of smoking cessation	Raw et al (1) are right to draw attention to the risk posed to smoking cessation services from April 2002. In Shropshire, the Help 2 Quit (NHS Beacon) service offers intensive nurse support and treatment at all GP surgeries. More than 3,000 patients received the service last year, and the numbers attending are growing all the time. The service is extremely cost-effective (an estimated cost of £300 per life year saved). Primary care has enormous potential to help smokers quit but Primary Care Trusts cannot be expected to deliver on this potential without the necessary resources. There is a real danger that many services will collapse if central funding is discontinued. This is an important test of Government commitment: is it serious about reducing smoking or not? 1. Raw M, McNeill A, Watt J, Raw D. National smoking cessation services at risk. BMJ 2001;323:1140-1.