Smoking cessation aids: state of the reimbursement situation

Can the recent increase in the reimbursement of smoking cessation aids significantly reduce smoking in France?

On the occasion of World No Tobacco Day on May 31, 2017, Alcimed, a consulting company specializing in innovation and the development of new markets, is taking a look at the available smoking cessation support systems, their coverage by the public health authorities and the conditions for successful smoking cessation.   

State of tobacco use in France

The French population now includes about 13.4 million smokers with smoking being considered as the leading cause of preventable death in the country, causing about 66,000 deaths each year.

According to Pierre Kopp’s 2015 report on “The social cost of drugs in France”, the social cost of tobacco currently amounts to €120 billion per year. It includes the overall value of human lives lost, the loss of quality of life, the production losses of companies and governments, but also the costs of prevention, enforcement and care. And all of that is compared to the sum of tobacco tax revenues and unpaid pension expenditure savings, estimated at only €25 billion.

Given the medical and economical consequences of tobacco, the French authorities have recently increased measures to promote smoking cessation.

N.B.: Statistics on tobacco in France (2016):
~ 13.14 million smokers
~ 66 000 deaths/year
Social cost estimated at 120 billion € / year
~2 million people in process of quitting/year
The average length of smoking cessation therapy is 3 to 12 months
On average, 3 to 4 attempts are required before long-term success

Smoking cessation aids

Various measures to help people stop smoking exist, including nicotine substitutes (patches, gums, lozenges, inhalers, etc.), which are the most commonly used by people attempting to quit smoking. Another measure, the electronic cigarette, is consumed by fewer than 2 million people. Champix®, a drug that reduces withdrawal symptoms and the pleasure of smoking by decreasing the sensitivity of the nervous system to nicotine, is also available. It is normally prescribed as a last resort when no nicotine substitute has been effective.

Among these different measures, the French Health Insurance reimburses nicotine substitutes and Champix®. In 2006, the French government introduced a flat-rate reimbursement of nicotine replacement treatments of up to €50 per person per year, which was increased to €150 in October 2016 following a decision of the Ministry of Health. Champix® has been partially reimbursed for smoking substitution treatment since April 2017 with a coverage rate of 65%.

N.B.: Nicotinic substitute reimbursement conditions
150 € reimbursed per person per calendar year
Subject to prescription by a health professional (doctors, midwives, dentists, nurses and physiotherapists)
A flat rate corresponding to approximately 3 months of substitution treatment for an average smoker
Possibility of additional coverage by certain insurers

The impact of nicotinic substitute reimbursement in other countries

The reimbursement of substitution treatments is intended to encourage the attempts to quit, especially among heavy smokers and those less fortunate, and is generally welcomed by health professionals.

However, similar measures in other countries have had only limited success.

Canada introduced the reimbursement of nicotinic substitutes in 2000. A study conducted on 25,000 respondents recorded almost no change in the incidence of smoking between 2005 and 2012 (24.4% to 23.8%). On the other hand, a significant decrease was recorded between 2012 and 2014 (23.8% to 19.6%) which can be attributed to 3 increases in tobacco taxes over this period.

The Netherlands has had a reimbursement system in place since 2013, following a first initiative in 2011. A decrease in the number of smokers was observed in the first year of the program, from 26% to 23% of the population, and then stabilized at around 23%. A media campaign launched in parallel to the reimbursement of smoking cessation programs has helped promote the use of the reimbursed treatments and increase their success rate. The reimbursement is part of a comprehensive smoking cessation program that includes several mandatory individual counselling sessions (group, face-to-face or telephone counselling) prior to obtaining the refund. Analysts explain the stabilization in the number of smokers after a few months by the fact that once the population of smokers who were waiting for a signal to quit was already engaged, the impact of the program on remaining or new smokers became limited and the smoking cessation rate returned to normal.

Health professionals unanimously agree that substitution treatments are useful, but the smoker’s motivation to quit and the quality and regularity of the support they receive are critical factors for successful cessation in the long term.

N.B.: Types of smokers
Heavy smoker: More than 10 cigarettes per day
Daily or regular smoker:  At least one cigarette per day
Occasional smoker : Less than one cigarette per day

Measures taken by France

The actions taken recently in France should thus lead to a measurable reduction in tobacco consumption in the relatively short term, but can only be a first step forward and needs to be reinforced by a set of complementary measures. Communication, providing a system that includes systematic support for smokers by a health professional, increasing tobacco-related taxes or maintaining neutral packaging are all part of a global approach to maximize the success rate of smoking cessation. Europe-wide measures, including those on price alignment, are also on the table and will need to be considered if the results are to be consolidated throughout the continent.