Costs and effects associated with a community pharmacy-based smoking-cessation programme

Objective: The aim of the study was to determine the costs and effects associated with a community pharmacy-based smoking-cessation programme in Northern Ireland, using the perspective of the payer in the main analysis. Design and setting: Data from a pilot study conducted in 2 community pharmacies in Northern Ireland were used as the basis of the current study, which examined the cost effectiveness of a formal counselling programme for smoking cessation by community pharmacists throughout Northern Ireland. A number of assumptions were made in the baseline analysis (e.g. annual rate of smoking cessation in the absence of the programme; lifetime relapse rate), and these were varied in the sensitivity analysis. Patients and participants: The pilot study upon which the main analysis was based was carried out in 2 Belfast pharmacies over a 2-year period. 52 people entered the smoking-cessation programme (group 1), 48 bought nicotine gum and gave their address so that additional information could be sent and they could be followed-up (group 2), and 60 people who expressed a wish to stop smoking were chosen on the basis that they matched, by age, gender, social status and disease status, those in group 1. Thirty-five of those in group 1 requested to use nicotine gum. A statistically significant difference (p < 0.01) was found in cessation rates between intervention and control patients. Interventions: The Pharmacists Action on Smoking (PAS) model was the only active intervention used in the study. The model was developed by the PAS group in association with the National Pharmaceutical Association (NPA) in the UK in 1994, and was designed specifically for use by community pharmacists to provide advice and motivation to help smokers stop smoking. The 4-stage model involves a written 'contract' between the patient and pharmacist (including a 'stop date'), and a series of brief counselling meetings over a period of approximately 6 months. Main outcome measures and results: Our findings indicate that the cost per life-year saved when using the PAS programme ranges from 196.76 pounds sterling (pound) to pound 351.45 for men and from pound 181.35 to pound 772.12 for women (1997 values), depending on age. This compares favourably with other disease prevention medical interventions such as screening for hypertension or hypercholesterolaemia. Conclusions: These findings provide an argument for adoption and remuneration of the PAS model in the community pharmacy (primary healthcare) setting.