Prescribing of Smoking Cessation Interventions in Scotland

March 2007

Introduction

Aids in stopping smoking are now available on NHS prescription as an adjunct to support and counselling services. Bupropion Hydrochloride (also known as Amfebutamone Hydrochloride, proprietary name Zyban®) became available on prescription in June 2000 and Nicotine Replacement Therapy (Nicorette^®, Nicotinell^®, NiQuitin CQ^® ) became available in April 2001. The ability to prescribe Nicotine Replacement Therapy (NRT) was extended to nurse prescribers in May 2001.  Varenicline (Champix^® ) was accepted for use by the Scottish Medicines Consortium (SMC)  in January 2007, but no data on its usage on prescriptions is available yet.

The National Institute of Clinical Excellence (NICE)   issued recommendations in March 2002 that smoking cessation products should be available on prescription to smokers who have made a commitment to stop on or before a target stop date. Prescriptions subsequent to the initial commencement of treatment should only be issued to the person if they can demonstrate that they are still trying to stop smoking. If the attempt to stop is unsuccessful, NICE recommends that Bupropion or NRT should not be prescribed again within six months, depending on individual circumstances.

On the 26th of March 2006, a ban on smoking in public places was introduced as part of the Smoking, Health and Social Care (Scotland) Bill to improve public health.

Information on prescribing for cigarette smoking can be found on the following Internet sites:

• NICE Guidance
• Action on Smoking and Health (ASH)
• Clearing The Air, the Scottish Executive's site detailing the ban on smoking in public places
• You Can Stop Smoking, NHS Health Scotland's web site
• The Scottish Public Health Observatory's Tobacco Use Site

ISD is not responsible for the contents of external Internet sites

Summary

The prescribing of smoking cessation products in Scotland between 2000 and 2006 has been reviewed.  A summary of the findings is given below.

• Prescribing of smoking cessation products shows seasonal variation.
• The sharp peaks around the months of January, February and March may be due to New Year Resolutions, while the steady decline after March may be due to successfully quitting or else relapsing.
• Prescribing of smoking cessation products rose sharply just before the introduction of the ban in smoking in public places was introduced in Scotland in March 2006.
• Of the prescribable treatments for smoking cessation, NRT is the most prevalent.

Data Source

Practitioner Services   , a division of NHS National Services Scotland, processes all NHS prescriptions for payment of pharmacies, dispensing doctors and appliance suppliers.  This gives a full record from which trends in prescribing can be investigated at a detailed level.  The data includes prescribing by GPs, nurses, dentists, pharmacists and hospitals, where the latter was dispensed in the community.  Hospital dispensed prescriptions are NOT included in the figures. These data do NOT include smoking cessation products purchased "over the counter".  Prescriptions processed internally by Boards for payment purposes are NOT included in these data.

A method of examining prescribing levels using different formulations of products (for example chewing gum, patches and tablets) is the defined daily dose (DDD) as developed by the World Health Organisation (WHO)   .  A DDD is defined as the assumed average maintenance dose per day for a drug used on its main indication in adults .  DDDs are derived from the international use of the substance in question.  As British prescribing patterns may differ from the accepted international value, each DDD should be regarded as a technical value, a close approximation of an average of the actually used doses.  The DDDs are therefore not necessarily the most frequently prescribed or used doses.

WHO defined daily dose (DDD) values for smoking cessation products available on prescription are shown in the following table:

Note:Varenicline does not yet have a DDD

This value offers an explanation of what proportion of the population may receive a certain drug treatment.  For example, an estimated drug consumption of 10 DDDs per 1,000 population per day corresponds to a daily use of the drug by 1% of the population.  The population used in this review is the mid-year estimates produced by the General Registrar Office for Scotland (GRO), but restricted to individual aged 16 and over, the most likely group to be prescribed the above drugs.

Seasonal variation in prescribing for smoking cessation

Monthly trends in the prescribing of smoking cessation products are shown in the figures below.

Figure 1 - Prescribing of All Smoking Cessation Products - Scotland 2000 to 2006  
 
Source: Information Services Division, Healthcare Information Group
Note: Excludes preparations bought over the counter or prescriptions processed internally by NHS Boards

Figure 2 - Prescribing of Smoking Cessation Products - Scotland 2000 to 2006

Source: Information Services Division, Healthcare Information Group
Note: Excludes preparations bought over the counter or prescriptions processed internally by NHS Boards

The gross ingredient cost, that is the cost of drugs before the deduction of any supplier discount and patient charges, is given in figure 3.

Figure 3 - Gross Ingredient Cost (£)  of Smoking Cessation Products - Scotland 2000 to 2006


Source: Information Services Division, Healthcare Information Group
Note: Excludes preparations bought over the counter or prescriptions processed internally by NHS Boards.

The data presented in figure 1 indicates that the number of patients making daily use of smoking cessation products at March 2006 is around 32,000.  It must be emphasised that these figures are estimates, the actual patient base is not known. 

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