Intended for healthcare professionals


National smoking cessation services at risk

BMJ 2001; 323 doi: (Published 17 November 2001) Cite this as: BMJ 2001;323:1140

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.

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

Competing interests: No competing interests

17 November 2001
Jonathan Foulds
Associate Professor
University of Medicine and Dentistry of New Jersey - School of Public Health, NJ 08901