The tobacco endgame

endgame tobacco

Could restricting tobacco sales to only pharmacies, combined with cessation advice in these settings, accelerate progress towards a tobacco-free future?

New Zealand researchers have aimed to quantify the impacts of a hypothetical intervention package on future smoking prevalence, population health and health system costs.

In the first study of its kind, they used an intervention package that involved restricting tobacco sales to pharmacies only, including the provision of cessation advice.

The University of Otago researchers chose New Zealand as the setting for the study, since the country has an ‘endgame’ goal for a tobacco-free future.

They used two peer-reviewed computer simulation models to forecast smoking prevalence across a population, and model for for future health gains and costs by sex, age and ethnicity.

For a ‘base component’ they estimated recent annual trends in smoking uptake and cessation by sex, age and ethnicity (Māori/indigenous population and non-Māori/non-indigenous).

These rates were then used as inputs for the ‘forecasting component’ to project future smoking prevalence from 2011 until 2060, for business-as-usual and for additional changes in future prevalence from restricting tobacco sales to pharmacies and the provision of cessation advice.

Greater costs due to increased travel distances to purchase tobacco were treated as an increase in the price of tobacco.

Annual cessation rates were multiplied with the effect size for brief opportunistic cessation advice on sustained smoking abstinence.

The intervention package was associated with a reduction in future smoking prevalence, such that by 2025, prevalence was 17.3%/6.8% for indigenous/non-indigenous populations compared to 20.5%/8.1% projected under no intervention.

Under the intervention measure, they estimated the populations would accrue 41,700 discounted quality-adjusted life-years (QALYs) (95% uncertainty interval (UI): 33,500 to 51,600) over the remainder of the 2011 NZ population’s lives.

Of these QALYs gained, 74% were due to the provision of cessation advice over and above the limiting of sales to pharmacies.

“This work provides modelling-level evidence that the package of restricting tobacco sales to only pharmacies combined with cessation advice in these settings can accelerate progress towards the tobacco endgame, and achieve large population health benefits and cost-savings,” say the authors of the paper published in the BMJ.

Earlier this year, the same researchers explored the attitudes of New Zealand pharmacists towards such schemes, conducting interviews at 30 pharmacies in Wellington.

They found that just a quarter were ‘very likely’ to sell tobacco if pharmacies were the only legal outlet for its sale, but this proportion increased to over a third if the strategy had been proven to work elsewhere in the world.

Internationally the trend is to move away from pharmacy tobacco sales: in 2014, US chain CVS Health became the first national retail pharmacy chain to stop selling tobacco products in all its stores.

Its research later found that since the move, there had been a downward trend in cigarette consumption in states where CVS had 15% or more share of the retail pharmacy market compared to states with no CVS Pharmacy stores.

The study also showed a four percent increase in nicotine patch purchases in those same states during the period immediately following the end of tobacco sales.

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