Electronic Cigarette Consumer Association UK

NHS Quit Smoking: Massive Fail

Statistics on NHS Stop Smoking Services: England, April 2009 - March 2010
http://www.ic.nhs.uk/pubs/sss0910

"Total expenditure on NHS Stop Smoking Services was just under £83.9 million, over £10 million more than in 2008/09 when it was £73.7 million and almost £60 million more than in 2001/02 when the cost was £24.7 million. The cost per quitter was £224, an increase of 3 per cent from £219 in 2008/09. These figures do not include expenditure on pharmacotherapies."

The figures seem to refer only to England, and only to the national programme, and without the cost of the drugs and treatments used. Therefore all-UK costs including drugs and including all GP-managed treatment will be substantially higher. Since double this figure allows for drug costs [1], a total cost for all UK-wide smoking related treatment approaching £200m seems likely. In addition the cost per quitter can also be shown to be wildly inaccurate.

These services are sometimes referred to as the Stop Smoking Services, so SSS seems a useful abbreviation. 49% of SSS users reported themselves as successfully having quit at 4 weeks. However only 69% of those tested clean, 31% revealing from failed tests that they were still smoking. The cost per quitter (at 4 weeks) is reckoned as £224, which is a very commendable figure, truth be told. It certainly looks like value for money. Unfortunately the figure is meaningless because it does not include the cost of the drugs, which is likely to be substantial, or refer to the real figure: the success rate at the standard 20-month mark used to measure ultimate success.

In addition the cost almost certainly refers to the the self-reported 49% successful subjects, 31% of whom were proven to have reported inaccurately (the real 'success rate' at 4 weeks is 34%). We also know that such figures drop to under 10% when measured at the 20-month mark, which is the only accurate measure of success. If a smoker has quit, then they will not be smoking two years later - if they are, then they have not quit and the effort was wasted. Given this fact, the cost per quitter rises to a substantial amount; and when the cost of the drugs is included, it does not represent either value for money or a successful overall result, whatever might be used as the determinant. The cost will in fact rise to several thousand £s per successful quitter. The real cost, though, is the harm caused to the 90%+ of the NHS programme participants who will return to smoking.

It is, ultimately, unfortunate that the £224 figure is quoted at all, since it starts to look like an attempt to mislead.

The 6-month success figure is not yet available but in the past was reported as 15%. The 4-week success rate is not regarded as of any practical use or importance by any independent expert analysts. A 20-month standard measure figure has never been provided for the NHS service, but all such figures for pharmaceutically-assisted cessation are typically under 10%, a result seemingly confirmed by the previously-reported figure of 15% success rate for the NHS programme at 6 months. That is to say, over 90% will fail and return to smoking.

Scotland

NHS Scotland has just published some more complete stats, at Q1 2012, and report a 1-year success rate of 8% for their quit-smoking services. We know this is in the right ball park as it is a standard figure for averaged pharma-assisted methods plus mentoring at the 12-month mark. The success figure drops about 50% per 6 months for all methods on average, so we can assume a 4% success rate for the NHS services in Scotland, at the standard 20-month mark. This is a good figure for pharma-assisted methods, mentoring being the key - without it, success can drop to 2% or less. Compared to other methods not using pharmacotherapies it is appalling poor, of course.

Run the numbers
Let us try to work out a true cost for each successful quitter within the main NHS Quit Smoking programme for England. This is not normally an exercise with any point, but since a figure has been quoted that almost seems an attempt to mislead, and since costs and value for money are being promoted as relevant by the NHS, it may be worth doing.

757,537 people entered the programme and set a quit date.

"At the 4 week follow up 373,954 people had successfully quit (based on self-report), 49 per cent of those who set a quit date."

The NHS are using a different type of maths from the normal version as this is not 49% (which is 371,193). Anyway, we will use the larger figure.

69% of this number were found to be truthful (31% failed a blood test and were therefore fibbing), which gives us 258,028 successful quitters at 4 weeks - about 34% of the start figure.

Let's check that number another way: we know the usual success rate at 4 weeks for pharma-assisted programmes is about 30% to 40% (various sources - references are not needed for this most useless of data), so the SSS figure of 34% looks about right.

We already know that less than 10% of pharma-assisted quitters make it to the 20-month mark, so we know that of the 757,537 who started, 75,753 or less will succeed. In a previous year, a 6-month success rate of 15% was published - but the 6-month rate is no longer reported. 15% seems a reasonable figure, although higher than other studies (normally 7% at 6 months). We will allow it as the support and assistance service may well be better than normal, and we know this is a critical factor in the success rates of these processes.

If 15% succeed at 6 months (or even at 12 months), then 10% at 20 months is far too optimistic. Nevertheless we will allow it as a 'best case' figure.

The actual cost per successful participant will therefore be several thousand £s - not the £224 misleadingly quoted. A best-case figure, for a 10% success rate at 20-months, is £2,178 (75,753 successful at a cost of £165m [1] ). It is likely to be more, since a 10% success rate is optimistic: a 7% success rate, a more usual figure, gives a cost per successful participant as £3,111. Even this may be too optimistic.

Final, accurate result
This allows us to sum up the NHS results as follows:

1. It appears the total cost for England, for the NHS main programme, is about £165m [1]. (For all SSS in England it may approach or exceed £200m - we do not know exactly what smoking-related treatment is or is not included in the SSS figures, in terms of all GP, clinic and hospital provision.)

2. The total UK cost for all countries and all quit smoking treatment will run into the hundreds of millions.

3. The actual cost per successful NHS main programme participant in England will be several thousand £s, not £224. It may be £2,178 as a minimum, but is likely to be £3,111 or more.

4. More than 90% of participants are likely to fail and return to smoking.

A programme using consumer harm reduction products would have at least five times the success rate at less than half the overall cost (and these estimates are a worst-possible-case scenario). The number of lives saved would be incalculably greater.

This being the case, it is understandable why the Department of Health, in this area, is considered by many to be incompetent, or worse.

No one knows why the DoH is so attached to the use of pharmaceutical treatments that are proven not to work, or is so determined to avoid use of consumer products such as Snus that, in contrast, are proven to work very well (Sweden has the lowest smoking-related mortality rate in the developed world by a wide margin).

An impartial observer would be forgiven for thinking that the saving of life may not be the #1 item on the agenda.

It is also immediately obvious where substantial savings could be made in the current economic climate, with the added benefit of far better performance (assuming that the saving of lives is the desired result).

The real agenda?
It has been suggested that instead of the saving of life being the primary goal, in fact the aims are to maintain pharmaceutical industry income and to keep the many thousands of people in this area of the health service employed, with the saving of life coming in at (a fairly distant) #3.

Although a rather cruel assessment, the facts do seem to support this view.

Future direction

As has been demonstrated, if there were any real intention of saving lives, there are two better solutions than pharmaceutical interventions:

• Motivated quit programmes are proven to work better than pharmacotherapies. The Allen Carr organisation's results make the NHS look like some kind of fraud.
• Consumer purchased Harm Reduction products would be used almost exclusively where assisted cessation was required, since there is no comparison between the effectiveness of pharmaceuticals and consumer products - the tobacco alternatives outperform the pharmaceuticals by orders of magnitude, whichever measure of success is used (and especially in the saving of life).

However it appears that the population has taken matters into its own hands. E-cigarette use at Q1 2011 reached approximately 3% of smokers. According to this 2005 study [2], smokers by themselves have already chosen an option that is equal to or better than 7 years of progress by the Department of Health and all others combined.

The study reports that current reduction in smoking is about 0.4% per year, effected by general measures such as tax rises and prohibition on advertising, plus a little help from the NHS. E-cigarette use at 3% (Q1 2011) equals 7 years of conventional progress, a 0.4% reduction over 7 years being 2.8%.

To quote from the study: "Reducing the prevalence of smoking by 1 percentage point each year for 10 years would prevent 69,049 deaths....."

Q4 2011
E-Cigarette use is now at 4%, and will continue to grow at a rapid rate. It is expected to reach 6% by 2013 or earlier.

It seems, then, as if smokers themselves have found a solution - one that elements within the DoH are trying to prevent or remove. If the current trend continues, NHS 'efforts' to reduce smoking prevalence will be redundant, rendered irrelevant by action by the smokers themselves.

Q1 2012
Useful stats are in from Scotland now [3]. This reveals the following useful info:

• Smoking in Scotland has increased.
• The number quitting is static, year on year.
• The success rate for the Scottish quit-smoking services is 8% at 1 year.

This gives us, at last, a published figure for the success rate at one year: 8%, a typical figure for pharma-assisted mentored interventions. It is pathetically useless compared to other methods known to be orders of magnitude more successful, at a fraction of the cost.

We have also now been shown, in recent independent clinical research, yet more proof that:

• NRTs don't work - and in fact contribute to the failure of quit attempts
• Clinical trials that showed they 'worked' were fixed, by using placebo control groups, members of which clearly knew they were not receiving nicotine or treatment and went back to smoking, falsely making the NRT stats look good, when in fact the real results were extremely poor.
• Two separate clinical trials that show Chantix has a 1 in 30 chance of causing a heart attack - apart from the large numbers of violent psychotic events and suicides for which it is famous.

Incidentally, Pfizer, makers of Chantix, have been convicted of what may be the largest criminal frauds in history, with fines of over one billion pounds, making them the biggest criminal liars in the world [5]. Thus we can see the sort of company the UK's Department of Health likes to keep. Some might say they are fine bedfellows.

John Polito has presented a convincing argument [6] that, instead of quit rates improving when pharma gained a stranglehold over government quit smoking services in 2000, the annual quit rates started to fall for the first time. At least, that's what the stats show, if you believe statistics. He also adds to the argument that clinical trials involving NRTs vs placebo are fraudulent.

Of course, you could always look at the facts instead. In every survey of ex-smokers, the vast majority always report they quit cold-turkey. If pharmaceutical interventions worked at all, that wouldn't be the case. It's as simple as that.

Conclusion

If e-cigarettes are allowed to flourish (and of course even more so if Snus were not banned), we can see that smoking-related mortality will begin to fall, independent from NHS or other efforts. And very fortuitously too, since the NHS efforts are clearly worthless. They are only responsible for a small proportion of the 0.4% annual reduction, since most expert commentators say that the tax rises and advertising blackouts are the main factors responsible for smoking reduction. No one knows the true figure, but the NHS might be responsible for a reduction of 0.1% per year or less - perhaps even 0.01%.

At a cost approaching £200 million a year, you might think it rather poor value for money.

We now also know, at Q1 2012, that in one UK country, Scotland, the number of smokers is increasing [4].

It is also clear that a torrent of lies issues from the DoH in order to cover up this situation.

• "The use of pharmaceuticals doubles your chances of quitting": an egregious lie - since lies of this type cause loss of life.
• "The cost per quitter in England was £224: an outright lie.
• Strong support for pharmaceutical interventions, always with associated comments or statements that this is the most efficient method for cessation of smoking: outright lies.
• A graph issued by NHS Scotland which purports to show, by a misleadingly-shaped graph, that smoker quits are increasing each year, whereas in fact they are static (as nicely shown by F2Choose Scotland). A lie by distortion.

The Allen Carr organisation's quit programme has a proven 53% success rate; switching to Swedish Snus has a proven 40% success rate and proven identical health outcomes to total cessation [7]; and switching to e-cigarettes has an anecdotal 75% success rate and an assumed equivalency to Snus and/or total cessation in health outcomes.

None of these need the blatant lies the DoH issues to cover up its miserable ~8% success rate and massive waste: huge contributions to the pharma industry which are, in effect, nothing better than taxpayers' money flushed down the toilet.

_________________________________

Notes

[1] In 2004 the reported costs of the services and the drugs were about equal (£30m and £32m) - see figures below. If we assume the same proportions prevail now, and the services cost is £84m without drugs, then £165m including drugs seems about right.

Statistics on NHS Stop Smoking services in England, April to December 2004
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_4110344

"The cost of prescription items prescribed in GP practices in England that were dispensed in the community in the period April to December was £26.4 million for NRT, £3.7 million for bupropion (Zyban) - a total of £30.1 million.
The expenditure on NHS stop smoking services, which does not include the cost of NRT or bupropion on prescription, was £32.3 million."

We may be reading this incorrectly but the cost of Champix does not seem to be included (it is not an NRT, but a psychotropic drug). If Champix (Chantix / varenicline) is excluded - then what else is missing?

[2] Public health measures to reduce smoking prevalence in the UK: how many lives could be saved?
Lewis, Arnott, Godfrey, Britton, 2005
http://www.ncbi.nlm.nih.gov/pubmed/16046688

"Reducing the prevalence of smoking by 1 percentage point each year for 10 years would prevent 69,049 deaths....."

"INTERVENTIONS: Population measures of proven effectiveness assumed to reduce smoking prevalence by 1 percentage point per year for 10 years, or alternatively by 13% over 19 years (1 percentage point per annum for seven years, 0.5 percentage point per annum for 12 years) as considered to be achievable in a recent report to the UK Chancellor of the Exchequer." *

*Such a report, if it actually existed, would consist of either wild speculation or outright lies, depending on your point of view. There is no possible way that current measures could reduce smoking prevalence by 1% per year. As to their being value for money, as seems to be the purpose of a report to the Chancellor, only a lunatic would consider that point valid, when made aware of the cheaper and vastly more effective alternatives.

"Continued prevalence reductions at the current rate of 0.4 percentage points each year will prevent 23,192 deaths over 10 years." *

*A rate massively outperformed by e-cigarettes already.

[3] The Scottish data shows us another view of health service stats, which allows us to deduce information about England that is not published.

http://f2cscotland.blogspot.com/2011/12/scottish-smoking-cessation-statistics.html

[4] http://f2cscotland.blogspot.com/2011/11/ban-fails-to-reduce-smoking-rate-in.html

[5] http://news.bbc.co.uk/1/hi/business/8234533.stm

[6] http://whyquit.com/pr/021112.html

[7] Snus is shown by more than 150 clinical trials and surveys, over more than 25 years, with large-cohort trials of tens of thousands of subjects, to have no elevated risk for any cancer, cardiac or vascular disease. There are two or three trials that show an increased risk for pancreatic cancer or stroke (but not oral cancer of any kind). However, large-scale meta-analyses of 89 and 150 trials by Lee and Hamlin show that a Snus user has the same risk as a non-smoker. 

http://www.ncbi.nlm.nih.gov/pubmed/17498798
http://www.ihra.net/files/2011/07/13/Rodu_-_Burden_of_Mortality.pdf
http://www.ihra.net/files/2011/07/13/Bates_-_EU_Statement.pdf
http://www.biomedcentral.com/1741-7015/7/36
http://www.ncbi.nlm.nih.gov/pubmed/21163315
http://tobaccocontrol.bmj.com/content/12/4/349.full
http://www.ncbi.nlm.nih.gov/pubmed/17498797
http://www.ncbi.nlm.nih.gov/pubmed/17498798
http://www.ncbi.nlm.nih.gov/pubmed/12930202
http://tobaccocontrol.bmj.com/content/15/3/210.abstract
http://www.biomedcentral.com/1471-2458/5/31
http://tobaccocontrol.bmj.com/content/12/4/372.full?sid=e5226a5e-ec70-40e5-bdf7-044cb7af3e75