Intended for healthcare professionals


Paying for nicotine replacement therapy is cheaper than smoking <20 cigarettes a day

BMJ 1999; 318 doi: (Published 27 February 1999) Cite this as: BMJ 1999;318:604
  1. Robert Bunney, General practitioner (rbunney{at}
  1. Brannam Medical Centre, Barnstaple, Devon EX32 8QB

    EDITOR—Fowler and Smeeth propose making nicotine replacement therapy available on the NHS, believing its high retail price remains prohibitive to many people.1 A typical eight week course of patches of 21mg/24 h bought from a pharmacy costs £17 a week, but smokers of 20cigarettes a day will save roughly £20 a week through not smoking while using the patches.

    In the Cochrane systematic review of 47trials including 23000 patients, nicotine replacement therapy doubled smoking cessation rates at 6-12months compared with placebo.2 The authors point out, however, that the absolute probability of abstinence for an individual remains low, and 15patients would have to use nicotine replacement therapy to produce one extra abstainer. The authors also note that there seems to be evidence of publication bias against negative trials and that compliance with nicotine replacement was lower among smokers treated in primary care.

    I am surprised that the editorial overlooks the fact that smokers save money even while paying for their nicotine replacement therapy. This should be borne in mind before yet more pressure is added to the already strained NHS prescribing budget and motivated smokers who currently are using the skills of community pharmacists are encouraged to involve their general practitioner instead.


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