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Use of Pharmacotherapy for Smoking Cessation in Italy
Arch Intern Med. 2009;169(20):1927-1928.
In a cluster-randomized smoking cessation trial conducted in Germany on 577 smokers, cost-free nicotine replacement therapy (NRT) or bupropion hydrochloride reduced smoking-related morbidity at low cost.1 This adds to the accumulated evidence that NRT, bupropion, and varenicline tartrate significantly increase cessation rate and are generally well tolerated by smokers.2-3
Using data from 6 population-based surveys conducted in Italy between 2002 and 2007, we showed that pharmacotherapy for smoking cessation was used by less than 10% of smokers who had made at least 1 quit attempt.4 We provide herein updated information on the issue.
Methods
Data were derived analyzing data from a survey conducted in 2008 on 3035 individuals (1459 men and 1576 women) representative of the Italian population 15 years and older.5 The data were collected by trained interviewers using a structured questionnaire in the context of a computer-assisted personal in-house interview. Information on sociodemographic characteristics and on smoking behavior and attitudes was collected. In particular, current smokers were asked about their previous quit attempts and whether they had ever used pharmacotherapy (NRT and/or bupropion or other drugs). Former smokers were asked whether they had used pharmacotherapy to quit. Moreover, all participants were asked about their perception of the efficacy of free smoking cessation therapy.
Results
Of 668 current smokers, 10.7% had an intention to quit within the subsequent 6 months. Most of the Italian study population (77.3%) and of current smokers (75.0%) perceived as relevant the influence of free smoking cessation pharmacotherapy to reduce smoking prevalence and consumption. However, pharmacotherapy has been used by only 9.9% of current smokers who previously tried to quit at least once in their life and had been used only by 2.7% of former smokers.
Comment
Although NRT has been available in Italy since 1986 and bupropion since 1999,4 in 2008, the use of pharmacotherapy while attempting smoking cessation was still very low and has not increased since 2002.4 This is partly because the industry does not systematically promote therapy for smoking cessation in Italy. Moreover, the Italian Agency for Pharmaceuticals supported independent clinical research since 2005, but up to now it has never published calls for treatments for nicotine addiction.
More importantly, pharmacological support for smoking cessation is not covered by the Italian National Health Service (NHS).4 In contrast, the United Kingdom, Ireland, and Australia offer full reimbursement for smoking cessation, and in other countries, including the United States, Sweden, and France, partial coverage is offered. Covering the cost of these products increases the number of quit attempts and rate of success, which is still very low in Italy.4 Thus, the present data further support the importance that pharmacotherapy for smoking cessation is added to the list of medications covered by the Italian NHS.4 Besides saving lives, this could reduce the huge costs of treating smoking-related disease.6
AUTHOR INFORMATION
Correspondence: Dr Gallus, Istituto di Ricerche Farmacologiche Mario Negri, Via G La Masa, 19, 20156 Milano, Italy (silvano.gallus{at}marionegri.it).
Author Contributions: All the authors contributed to the final version of the manuscript. Dr Gallus had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: La Vecchia, Zuccaro, and Paleari, Cesario, Russo, and Apolone. Acquisition of data: Colombo and Zuccaro. Analysis and interpretation of data: Gallus, Tramacere, Cesario, Russo, Apolone, and Apolone. Drafting of the manuscript: Gallus and Tramacere. Critical revision of the manuscript for important intellectual content: La Vecchia, Colombo, Zuccaro, Paleari, Cesario, Russo, and Apolone. Statistical analysis: Tramacere. Obtained funding: La Vecchia and Zuccaro. Administrative, technical, and material support: Apolone. Study supervision: Gallus, La Vecchia, Colombo, Zuccaro, Paleari, Cesario, Russo, and Apolone.
Financial Disclosure: Dr Apolone has received consulting and lecture fees from GlaxoSmithKline, Italy.
Funding/Support: This work was supported by financial contributions from the Italian Ministry of Health, the Italian League Against Cancer, and the Italian Association for Cancer Research.
REFERENCES
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1. Salize HJ, Merkel S, Reinhard I, Twardella D, Mann K, Brenner H. Cost-effective primary care-based strategies to improve smoking cessation: more value for money. Arch Intern Med. 2009;169(3):230-236.
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4. Ferketich AK, Gallus S, Colombo P; et al. Use of pharmacotherapy while attempting cessation among Italian smokers. Eur J Cancer Prev. 2009;18(1):90-92.
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5. Tramacere I, Gallus S, Zuccaro P; et al. Socio-demographic variation in smoking habits: Italy, 2008. Prev Med. 2009;48(3):213-217.
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6. Pollock JD, Koustova E, Hoffman A, Shurtleff D, Volkow ND. Treatments for nicotine addiction should be a top priority. Lancet. 2009;374(9689):513-514.
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