Smoking interventions good value for money

HIQA has advised the Minister for Health that investing in interventions to help people quit smoking was effective and provided good value for money.

Dr. Mάirίn Ryan
Dr. Mάirίn Ryan

HIQA’s health technology assessment (HTA) was the first ever analysis carried out to compare the cost-effectiveness of alternative mixes of smoking cessation interventions with an existing standard of care, and the first assessment in the EU to examine the cost-effectiveness of e-cigarettes as an intervention to help people quit smoking.

The report found that all interventions were effective in helping people quit smoking, and were cost-effective when compared with unassisted quitting.

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HIQA’s Director of Health Technology Assessment, Dr, Máirín Ryan, said: “Smoking is a major public health problem in Ireland. One in five deaths each year is due to tobacco smoke. There are approximately 820,000 smokers in Ireland, with half making at least one quit attempt each year. Yearly expenditure on smoking cessation activity is estimated to be over €40 million. This HTA has found that providing these interventions to help people quit smoking not only works, but is good value for money.”

HIQA’s HTA recommended using varenicline (either alone or in combination with nicotine replacement therapy [NRT]) for smokers wishing to use some type of pharmacological support in their attempt to quit.”

Dr. Máirín Ryan said: “The Health Service Executive (HSE) should seek to increase the uptake of varenicline, either alone or in combination with NRT (nicotine patches), among smokers who wish to use pharmacological support in their quit attempt. Using varenicline alongside NRT is more than three and half times as effective as using no active medication. However, this is a relatively new combination of interventions, and any potential implications of widespread uptake need to be considered as part of the development of clinical practice guidelines and national health policy.”

Almost one in three people in Ireland use e-cigarettes in their attempt to quit smoking. Despite some promising results, HIQA determined that there was not enough evidence at present to reliably demonstrate their effectiveness as an aid to smoking cessation.

Dr. Ryan said HIQA advised the Minister to await the results of ongoing trials before deciding whether to recommend e-cigarettes. “A decision to advocate e-cigarette use should take into consideration any additional information on the long-term safety of e-cigarettes use, and any emerging data in relation to concerns about the social normalisation of e-cigarettes leading to increased uptake among people who have never smoked, or later migration to tobacco cigarettes.”

The report found that behavioural interventions, such as counselling and group behaviour therapy, were also effective in helping smokers to quit compared to quitting with minimal help. As pharmacological therapies were not acceptable to everyone, HIQA said it was important that behavioural interventions continued to be provided. It said the effectiveness of pharmacological therapies could be further improved when provided in combination with a behavioural intervention.

Dr. Ryan said: “The HTA also found that pregnant women who smoke should be offered a psychosocial intervention in the first instance. There is substantial evidence to support the effectiveness of counselling for this cohort of the population. While there is limited evidence for smokers who attend specialist secondary mental health services, high-intensity interventions that combine pharmacotherapy and behavioural support have been shown to improve quit outcomes. However, further research on the effectiveness of smoking cessation interventions in this population is needed.”

Smoking is the single biggest cause of illness, disability and death in Ireland.

Twenty three per cent of the Irish population smoke and about 19% smoke every day.

There are 6,000 deaths in Ireland per year attributable to smoking, every day.

Many hundreds of thousands more live with long-term illness and disability caused by smoking.

The largest group of smokers are aged 25-34 year olds (33%).  Smoking costs the publicly funded health services in Ireland €500 million annually.  In the acute hospital sector alone, smoking is responsible for more than 100,000 inpatient episodes – 1 in 3 due to respiratory disease, 1 in 5 due to cardiovascular disease and 1 in 10 due to cancer – all attributed to smoking.