Letter of the Day: Put quit-smoking medication on NHF card
THE EDITOR, Sir:
I had written to the National Health Fund in April 2015 requesting the listing of tobacco use disorder on the National Health Fund so that persons who desire to stop smoking would have access to subsidised quit-smoking medication.
I have not yet got a response and would like your assistance to bring up this important matter for public discussion.
The National Health Fund Form lists certain common chronic diseases for which subsidies are provided.
Tobacco use disorder is the single most preventable chronic disease.
It is not one of NHF's listed chronic diseases.
Smoking diminishes the benefits of statins.
Smoking diminishes the benefit of blood pressure control.
The cigarette is a sophisticated drug-delivery device. Three to four days of inhaling tobacco smoke are required to induce addiction to nicotine. Sixty per cent of smokers want to flee from this disease. Almost half will attempt to quit each year, mostly on their own. Of these, only four to seven per cent of smokers are successful. (Canadian Tobacco Use monitoring survey 2007.) Success doubles and triples with appropriate medication. Smokers need help.
Consider how cost-effective it is to treat for smoking cessation compared to the cost of treatment for hypertension and hyperlipidemia (per life year saved):
1. Treatment for smoking cessation - CDN$2,000-$6,000
2. Treatment for hypertension using diuretics - CDN$9,000-$26,000
3. Treatment for hyperlipidemia - CDN$50,000-$196,000
(Tengs TO, et al. Risk Anal. 1995; 278 (21); 1759-66
Franco OH, et al. Int. J. Technol. Assess Healthcare 2007; 23(1):71-9
Eddy DM et al Am J Med Qual. 2009; 24(3); 241-9)
Consider also the number of persons needed to treat using interventions to save one life before age 75 years (Woolf SH JAMA 1999:282 (24):2358-65)
1. Smoking cessation, 8
2. Lowering of lipids, 16
3. BP control with diuretics, 34
Quitting smoking after an infarction reduces death by 36 per cent and reinfarction by 32 per cent.
Smoking cessation is superior to other proven cardiovascular interventions.
Cessation is associated with reduced rate of restenosis after percutaneous coronary intervention and reduced rates of blockage of coronary bypass graft.
Smokers need your help. The amazing ability for smokers to quit smoking improves with the use of appropriate medication and strategic support. When the National Health Fund lists tobacco use disorder on the NHF card, it will help Jamaica to meet the World Health Organization's FCTC MPOWER policy guidelines for countries.
VP, Association of General Practitioners of Jamaica