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January 15, 2011

Drugs to Stop Smoking

At the start of National Non-Smoking Week, Christy Clark announced if elected premier she will reinvest proceeds from tobacco taxes into nicotine replacement therapies and cessation products. Rival Kevin Falcon, Health Minister until he entered the Liberal leadership race, quickly chimed in saying he supports the initiative by Clark and the Clean Air Coalition (composed of the Heart and Stroke Foundation of B.C. & Yukon and the BC Lung Association). Quebec has provided such coverage for 10 years; Saskatchewan announced coverage starting this month. Clark and Falcon didn't mention whether they would follow Saskatchewan's lead in banning the sale of tobacco in pharmacies, a policy that will take effect April 1st in that province.

The Coalition says that: "Nicotine replacement therapies (NRT) - such as nicotine gum, "the patch" and inhalers - and prescription drugs - such as Champix and Zyban - are important tobacco cessation aids, which for many improve the chances of quitting." Keep in mind that a one pack-a-day smoking habit costs the smoker roughly $7,000 per year; nevertheless, the coalition argues that publicly financed support is required because the therapies can be too expensive for some when they continue to smoke in the early stages of trying to quit The monthly cost of bupropion is a little more than 2 packs of cigarettes; varenicline costs more but not on a cost-effectiveness basis, equal to about 7 packs of cigarettes per month.

The Coalition's website includes a link to the September 2010 Canadian Agency for Drugs and Technologies in Health (CADTH) 548 page report "Pharmacologic-based Strategies for Smoking Cessation: Clinical and Cost-Effectiveness Analyses". The study found that the cost-effectiveness of varenicline and bupropion is between $4,000 and $10,000 per quality-adjusted-year-of-life (QALY) gained, depending on age and gender. Unfortunately the reports analysis of public or private insurance coverage of the drugs was limited to comparing full reimbursement of bupropion and NRT (gum, patch, and inhaler) with no reimbursement of these drugs. It concluded that if an insurance plans threshold for coverage was $900 for an additional QALY, then full coverage is a more cost-effective option than not reimbursing for these drugs. Provincial drug plans, including BC's Pharmacare Plan, do not provide full coverage. Health economists generally agree that policies that cost less than $50,000 per QALY should be persued. On that basis BC should follow the examples of Quebec and Saskatchewan. The CADTH report did not discuss how strategies such as increasing tobacco taxes compare to drug strategies, leaving the question open as to whether inclusion of the drugs under Pharmacare is the most cost-effective strategy or simply a victory for the drug companies.

The Clean Air Coalition also calls for tobacco-free pharmacies, smoke-free outdoor public spaces and smoke-free housing options. It would be good to hear where the leadership candidates stand on those policies. Christy Clark was in cabinet when her government delayed the WCB initiative to end smoking in bars and casinos. When it came to stopping smoking on playgrounds and outdoor patios, the Liberal government punted the issue to the municipalities with the result that patio and playground smoking is banned in the Districts of North and West Vancouver but allowed in the City of North Vancouver. All of the Coalition's recommendations deserve support.