Insights in Chest Diseases

Keywords

Tobacco; Smoking; Efficiency

Editorial

Smoking is the most important preventable cause of morbidity and premature mortality in developed countries [1]. Indeed many diseases and pathological conditions are directly caused or linked to exposure to tobacco [2], such as tumors, non-tumor lung diseases like COPD (chronic obstructive pulmonary disease), infections, histiocytosis, cardiovascular diseases, among others.

In fact smoking is responsible for about 5 million deaths throughout the world. Other 600,000 people die from the "second hand" smoke (passive smoking). Tobacco kills more than tuberculosis, malaria and AIDS combined. If actions are not taken, it will likely kill 1000 million people in the 21^st century [3].

Indeed, it is a systemic disease included in the 2015 version of the International Classification of Diseases of the WHO (World Health Organization), in the F-17 part of the ICD-10 (mental and behavioral disorders due the consumption of tobacco) [4-6]. It belongs to the group of addictions listed by the Diagnostic and Statistical Manual of Mental Disorders (DSM V) [7] of the American Psychiatric Association.

As a result of it, it becomes a public health problem with a high prevalence, mortality and consumption of resources [8,9].

Without adequate support to quit smoking, only 3-5% of smokers will get it. We have treatments that have proven cost effective [10].

Proper diagnosis and treatment of tobacco dependence is based on psychological and pharmacological therapies. We mention three in particular: NRT (Nicotine Replacement Therapy), bupropion and varenicline [11].

In fact efficiency relates the results of an intervention with the costs invested, so it answers the question if the treatment is finally cost effective [12,13].

Although studies in Spain on cost-effectiveness of smoking cessation treatments are scarce they conclude [14]:

1. The cost per QALY (Quality Adjusted Life Years) gained would be between several hundred and a few thousand dollars, not so much.

2. The abandonment cost is also low.

3. There is an increased use of assistance in the period immediately before and after the abandonment time, but it is reduced to a great extent after a year.

4. Tobacco treatment produces a long-term cost savings by reducing healthcare consumption, increasing productivity and reducing insurance premium [15,16].

In hospitalized patients and pregnant ones, cost-effectiveness of treatments for smoking cessation is particularly favorable.

Some of the most effective treatments of COPD patients are some of the cheaper ones (for instance anti-smoking therapies), as the QALY pyramid for COPD shows (Figure 1) [17].

Figure 1: The QALY pyramid for COPD¹⁷. London respiratory team value pyramid. NHS (National Health Services) of England

In conclusion, it is hardly justifiable not to include anti-smoking therapies in Health Systems, especially in patients with certain diseases, hospitalized patients and pregnant women. Nicotine addiction treatments are the basis of treatment in COPD and other respiratory diseases patients.

Summary

Anti-smoking therapies are very cost effective. Then it is necessary to include these treatments in all Health Systems. Sometimes the most effective treatments are some of the cheaper ones, and in this case are the basis of many of them, for instance COPD, cardiovascular diseases, among others.

References

1. U.S Department of Health and Human Services (1989) Reducing the health consequences of smoking: 25 years of progress. A report of Surgeon General 1989. Rockville, Maryland. US DHHS, PHS, CDC, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No (CDC) 89-8411.
2. The health consequences of smoking: a report of the Surgeon General (2015) Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, DC, USA, 2004.
3. World Health Organization (2012) WHO Global Report: mortality attributable to tobacco. Geneva, Switzerland: World Health Organization.
4. The World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.
5. World Health Organization (2015) International Classification of Diseases (ICD).
6. de Granda Orive JI (2007) Cigarette smoking as addictive chronic disease. In: Jimenez-Ruiz CA and Fagerstrom KO (eds.), Tobacco Treaty, 2nd Edition, Madrid, Ergon,pp: 99-119
7. American Psychiatric Association (2013) Diagnostic and statistical manual of mentaldisorders, 5th edn: DSM V. Washington, DC: American Psychiatric Association.
8. Fagerström KO, Balfour D (2006) Neuropharmacology and potential efficacy of new treatments for tobacco dependence. Expert Opin Investig Drugs 15:107-116.
9. Agencia de Evaluación de Tecnologías Sanitarias (2003) Evaluation of efficacy, effectiveness and cost- effectiveness of different treatment approaches for smoking cessation. Madrid: AETS delInstituto de Salud Carlos III.
10. Hughes JR, Keely J, Naud S (2004) Shape of the relapse curve and long-term absti-nence among untreated smokers. Addiction 99: 29-38.
11. Rábade Castedo C, Lama López A, Dablanca Pallares M (2015) Smoker patient diagnostic approach. In: Diagnostic and treatment of tobacco dependence in daily clinical practice. Manual SEPAR de procedimientos 32:9-29.
12. Dilla T, Sacristán JA (2006) Economic evaluation of health interventions. Editions Doyma Barcelona. Depósito legal: M-37747-2006
13. Pinto JL, Sánchez FI (2015) Methods for economic evaluation of the new features. Ministry of Health.
14. Agencia de Evaluación de Tecnologías Sanitarias (AETS) (2003) Carlos III Health Institute. Ministry of Health. Evaluation of the efficacy, effectiveness and cost-effectiveness of different treatment approaches for smoking cessation, Madrid.
15. Warner KE, Smith RJ, Smith DG, Fries BE (1996) Health and economic implications of a work-site smoking-cessation program: a simulation analysis. J Occup Environ Med 38:981-992.
16. Cornuz J, Gilbert A, Pinget C (2006) Cost-effectiveness of pharmacotherapies for nicotine dependence in primary care settings: a multinacional comparison. Tob Control 15:152-159.
17. Williams S, Baxter N, Holmes S (2012) Impress Guide to the relative value of interventions for people with COPD. British Thoracic Society and the Primary Care Respiratory Society UK, British Thoracic Society Reports.