ABSTRACT
This paper summarizes and discusses the key findings of the evaluation of the English smoking treatment services, which were established in 1999 as part of the English National ...Health Service. Within 4 years these services existed throughout the country and were working at full capacity, a total of £76 million having been spent on them over this period, excluding medication costs. In the fourth year almost 235 000 people attended treatment and set a quit date, and the total budget, including medications, was approximately £50 million. At the end of the fourth year the government allocated £138 million for the services for the period April 2003–March 2006. The CO‐validated 4‐week abstinence rate was 53%, the validated 52‐week abstinence rate was 15%, and the relapse rate from 4 to 52 weeks was 75%. There was no sex difference in cessation rates at long‐term follow‐up. The cessation results and relapse rate from weeks 4 to 52 are consistent with results from published studies, including clinical trials. The estimated cost per life‐year saved was £684 and the figure is even lower if the potential future health care cost savings are taken into account at £438 per life‐year saved. This compares with the benchmark of £20 000 per life‐year saved, which the National Institute for Clinical Excellence (NICE) is using to recommend new health care interventions in the National Health Service. The services were also succeeding in reaching disadvantaged smokers. However, there have been problems, and other health care systems considering an initiative of this kind should: set national training standards and increase training capacity before launching the services; standardize the provision of pharmaceutical treatments and make them as accessible as possible before launching the services; and give the services at least 5 years of central funding to allow them to become well established. Monitoring is extremely important but should not be so much of a burden that it detracts from developing a quality service and although cessation targets can be helpful, care needs to be taken that they are reasonable and do not promote throughput at the expense of quality.
Cigarette smuggling, now on the increase, is so widespread and well organised that it poses a serious threat to public health. This threat comes from two principal directions. First, smuggling makes ...cigarettes available cheaply, thereby increasing consumption. A third of annual global exports go to the contraband market, representing an enormous impact on consumption, and thus causing an increase in the burden of disease, especially in poorer countries. It is also costing government treasuries thousands of millions of dollars in lost tax revenue. Second, the tobacco industry uses smuggling politically, lobbying governments to lower tax, arguing that smuggling is caused by price differences. This paper shows that the claimed correlation between high prices and high levels of smuggling does not exist in western Europe. In fact, countries such as Norway and Sweden, with expensive cigarettes, do not have a large smuggling problem, whereas countries in the south of Europe do. Cigarette smuggling is not caused principally by “market forces”. It is mainly caused by fraud, by the illegal evasion of import duty. The cigarettes involved are not the cheap brands from southern European countries, for which there is no international market. It is the well-known international brands such as Marlboro and Winston. We propose much tighter regulation of cigarette trade, including an international transport convention, and a total ban on transit trade—sale by the manufacturers to dealers, who sell on to smugglers.
BACKGROUND Employers have responded to new regulations on the effects of passive smoking by introducing a range of workplace policies. Few policies include provision of smoking cessation ...intervention. OBJECTIVE To estimate the cost to employers of smoking in the workplace in Scotland to illustrate the potential gains from smoking cessation provision. Costs vary with type of smoking policy in place; therefore, to estimate these costs results from a survey were combined with evidence drawn from a literature review. STUDY DESIGN A telephone survey of 200 Scottish workplaces, based on a stratified random sample of workplaces with 50 or more employees, was conducted in 1996. Additional evidence was compiled from a review of the literature of smoking related costs and specific smoking related effects. RESULTS 167 completed responses were received, of which 156 employers (93%) operated a smoking policy, 57 (34%) operated smoke free buildings, and 89 (53%) restricted smoking to a “smoke room”. The research literature shows absenteeism to be higher among smokers when compared to non-smokers. The estimated cost of smoking related absence in Scotland is £40 million per annum. Total productivity losses are estimated at approximately £450 million per annum. In addition, the resource cost in terms of losses from fires caused by smoking materials is estimated at approximately £4 million per annum. In addition, there are costs from smoking related deaths and smoking related damage to premises. CONCLUSION This study shows how smoking cessation interventions in the workplace can yield positive cost savings for employers, resulting in gains in productivity and workplace attendance which may outweigh the cost of any smoking cessation programme.
This outstanding cost effectiveness means that treating tobacco dependence will release resources for other uses, and relatively quickly. For example, the risk of myocardial infarction or stroke ...falls by around a half within the first two years after stopping smoking,9 and the potential savings to the drugs bill if more smokers stop is considerable.
Real partnerships need trust Raw, M
Addiction (Abingdon, England),
02/2000, Letnik:
95, Številka:
2
Journal Article
Recenzirano
Raw commenst on T. McCreanor et al's recent editorial "ICAP and the perils of partnership." Raw worries that, like the tobacco industry, the real worry with the alcohol industry and research is that ...no one is quite sure of anyone else's motives.
The World Health Organization estimates that tobacco will become the largest single health problem by 2020, causing an estimated 8.4 million deaths annually. But the smoking burden will not be ...distributed evenly across the globe; deaths in developed nations are set to rise 50% to 2.4 million while those in Asia will soar fourfold to an estimated 4.2 million in 2020. In the face of such discrepancy, Martin Raw, Honorary Lecturer in evidence-based treatment at Guys, Kings and St Thomas' School of Medicine, London, explains why attention can not be focused solely on Asia and why efforts are still needed to stop smoking in Europe.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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