The cost-effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking

Abstract

Objective - To assess the cost-effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking. Method - A randomised control trial was used to evaluate training of pharmacy personnel based on the 'stage of change' model. All 76 non-city community pharmacies registered in Grampian were invited to participate. All intervention personnel were invited to attend the training. Control and intervention groups then recruited clients over a 12-month period. Detailed records were kept of the costs borne by the health service, pharmacies and clients. The effectiveness of the training was assessed by comparing the smoking cessation rates of the two groups at one, four and nine months. Setting - Community pharmacies in the Grampian region of Scotland. Key findings - Sixty-two pharmacies (82 per cent) were recruited. The training was undertaken by 94 participants (40 pharmacists, 54 assistants). A total of 492 clients (224 intervention, 268 controls) was recruited. Assuming that non-responders had lapsed, intervention subjects tended to be more likely than control subjects to report not smoking at each follow up. As reported previously, one-month point prevalence was 29.9 per cent intervention and 23.6 per cent control (P = 0.12); four months' continuous abstinence was achieved by 16.1 per cent in the intervention group and 10.9 per cent of controls (P < 0.094) and nine months' continuous abstinence by 12.0 per cent in the intervention group and 7.4 per cent of controls (P < 0.089). The cost of producing one additional successful attempt to quit smoking by using intensive rather than standard pharmaceutical support was £300. Conclusion - The intervention was associated with higher smoking cessation rates, confirming that community pharmacy personnel have the potential to make a significant, cost-effective contribution to smoking cessation.