Student BMJ April 1999: Letters

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Robert Bunney
General practitioner
Brannam Medical Centre,
Barnstaple,
Devon EX32 8QB

rbunney@enterprise.net

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Paying for nicotine replacement therapy is cheaper than smoking 20 cigarettesand under a day

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 20 cigarettes a day will save roughly £20 a week through not smoking while using the patches.

In the Cochrane systematic review of 47 trials including 23,000 patients, nicotine replacement therapy doubled smoking cessation rates at 6-12 months compared with placebo.(2) The authors point out, however, that the absolute probability of abstinence for an individual remains low, and 15 patients would have to use nicotine replacement to produce one extra abstainer. 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.

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 are using the skills of community pharmacists are encouraged to involve their general practitioner instead.

Reference

1 Smeeth L, Fowler G. Nicotine replacement therapy for a healthier nation. BMJ 1998;317:1266-7. (7 November.)

2 Silagy C, Mant D, Fowler G, Lancaster T. Nicotine replacement therapy for smoking cessation. In: Cochrane Collaboration. Cochrane Library. Issue 2. Oxford: Update Software, 1998.

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