Attempting to increase the use

of smoking cessation

medications

Brendon Baker

Ministry of Health

Most people try to quit without support

Cold Turkey!

Quitting without support

The majority of people who quit this way will relapse in the first week

Only 2.5%

abstinent at 1-year

Why do smokers quit without support?

People who smoke• Don’t believe they need treatment• Don’t know about treatments• Can’t access treatments (cost and

availability)• Don’t believe treatments work

Why do smokers quit without support?

Healthcare professionals• May lack knowledge / feel unsure about

tobacco dependence and smoking cessation

• May hold similar beliefs to those of smokers

• Don’t believe they can help• Lack resources (time, money) to

help as they might like

Subsidised Pharmacotherapy

Odds ratio (95% CI) NNT

NRT 1.77 (1.66 -1.88) 17

Bupropion 1.94 (1.72 – 2.19) 13

Nortriptyline 2.34 (1.61 – 3.41) 13

Varenicline 3.22 (2.43 – 4.27) 7

Cochrane Library of Systematic Reviews

• Nicotine replacement therapy• Bupropion (Zyban)• Nortriptyline• Varenicline (Champix) (since 1 November

2010 on ‘special authority’)

New Sole Supply NRT agreement in 2011

Pharmaceutical andformulation Strength Pack size Proposed priceand subsidyNicotine lozenge 1 mg 216 $19.94Nicotine lozenge 2 mg 216 $24.27Nicotine patch 7 mg 28 $18.13Nicotine patch 14 mg 28 $18.81Nicotine patch 21 mg 28 $19.14

• Unlike the currently listed smaller pack sizes, no rebate would apply to the larger pack sizes of nicotine lozenges and nicotine patches.

NRT monthly expenditureNRT Drug Cost

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

$1,800,000

Jul-

06

Au

g-0

6S

ep

-06

Oct

-06

No

v-0

6D

ec-

06

Jan

-07

Fe

b-0

7M

ar-

07

Ap

r-0

7M

ay-

07

Jun

-07

Jul-

07

Au

g-0

7S

ep

-07

Oct

-07

No

v-0

7D

ec-

07

Jan

-08

Fe

b-0

8M

ar-

08

Ap

r-0

8M

ay-

08

Jun

-08

Jul-

08

Au

g-0

8S

ep

-08

Oct

-08

No

v-0

8D

ec-

08

Jan

-09

Fe

b-0

9M

ar-

09

Ap

r-0

9M

ay-

09

Jun

-09

Jul-

09

Au

g-0

9S

ep

-09

Oct

-09

No

v-0

9D

ec-

09

Jan

-10

Fe

b-1

0M

ar-

10

Ap

r-1

0M

ay-

10

Jun

-10

Jul-

10

1st NY ad campaign & annual CPI adjustment

Quit Cards online

Prescribers giveout Quit Cards

On prescription

Excise tax

Prescribing of NRT

Prescriptions issued for 21 mg patches:

• September 09 – 814 (5012 Quit Cards)

• May 10 – 1802 (8031)• July 10 – 1847 (5379)

Prescribing of Zyban

Sep 09 – 2168 scripts

July 10 – 3935 scripts

Where to from here?

Māori Affairs Select Committee recommendations

• Tobacco companies should pay for meds

• NRT required to be sold everywhere tobacco is

• Allow Pharmacists to be Quit Card providers

Conclusions

There has been significant progress made

More can be done - still 650000 smokers

Potential growth areas:• Prescribers• Champix/Zyban/Nortripyline• Māori Affairs Select Committee

Recs