How much does smoking cessation (SC) medications impacts on the income of the attendees of a smoking cessation clinic? A cross-sectional study

Abstract

Introduction: Promoting effective use of SC medications is a priority. Nevertheless, SC medications are reimbursed in a few countries.

Aim: To assess the cost of SC treatment; and how much it impacts on the income of smokers' attending a cessation clinic in Covilha, Portugal.

Methods: Questionnaire-based cross-sectional study systematically carried out during clinical interviews. Chi-square, Mann-Whitney tests and logistic regression were performed.

Results: Participants: 503 smokers; mean age 47 ± 12.5 years; 66% males; most belonged to low socioeconomic status (SES); 86% smoked boxed-cigarettes (BC); 13% roll-your-own (RYO). Mean consumption was 23 ± 10 cigarettes/day; median duration of smoking was 30 years. Nicotine dependence was high in 27.5% and moderate in 60% of smokers. The median of monthly income was 600€. According to the modality of medication prescribed, SC costs per month were: 1) varenicline 2 mg/day=€88.6; corresponding to 16.2% (95%CI:15.2-17.2) of their monthly income; 2) varenicline 2mg/day + 3 oral NRT/day NRT=€123.2; corresponding to 22.5% (95%CI:21.2-23.9) of their monthly income, p<0.05; 3) NRT patch 21 mg + NRT 6 oral/day=€161; corresponding to 29.4% (95%CI:27.7-31.2) of their monthly income, p<0.001. Despite that RYO smokers' income was significantly lower than BC smokers', the burden of medication on the income of RYO smokers was significantly higher than BC smokers (>2x).

Conclusions: SC medication represents a major burden on smokers' income, especially on RYO users and those socially disadvantaged. This may undermine smoking cessation, urging for the need for reimbursement of cessation medication.