Is the New Zealand Quitline & NRT distribution programme appropriately resourced? Nick Wilson* (Otago University, Wellington) Chris Bullen (Auckland University, Auckland) George Thomson (Otago University, Wellington) *Health Promotion and Policy Research Unit (HePPRU) nick.wilson@otago.ac.nz

High need for smoking cessation support Note ethnic group %s in population

Demand for Cessation Support Most smokers in developed countries (>80%) regret starting (ITC Project data). NZ data consistent with this 65% of NZ smokers have made a quit attempt in past 5 years (NZTUS 2006 data)

Programme description: Quitline & NRT On-going mass media campaigns promote the free phone Quitline Eligible callers sent a voucher (‘Quitcard’) redeemable at pharmacies Subsidy is around 95% of the retail price of NRT

Reach of the Quitline 1.3% of all smokers register with the Quitline every 6-month period (n>30,000 / year) Quitline is most popular source of advice (>friend/family or GP) (NZTUS data) Callers & NRT dispensing – responsive to paid advertising (including for Māori & Pacific)

Evaluation of Programme Components Access nationwide & to all ethnic groups – but Pacific smokers under- represented 2002/03 evaluation: Processes well accepted – 70% used whole 4 week course of NRT. Voucher redemption rate (>=1 voucher): 76% of Māori; 87% of non- Māori (p<0.001) For full details see http://www.quit.org.nz

Service effectiveness is relatively high 12-month self-reported quit rate: 18% 6-month self-reported quit rates (intention-to- treat analysis): 17% for Māori, 22% non- Māori Māori NRT redemption associated with increased quitting at 6 months: OR=1.78 (1.00–3.16) For full details see http://www.quit.org.nz

Cost-effective Including counselling + NRT costs: Cost per smoker who quit for a year: $2099 - 4272 Cost / lifetime quitter: $3198 – 7120 Cost / QALY gained: $2449 – 6794 (much better than breast screening) NB: Conservative assumptions (ignored short- term health gains, work productivity).

Programme strengths Accessibility good – nationwide reach & low price High user acceptability Political acceptability (print media data) Effective (quit rates) & cost-effective (per quitter, per QALY) Sustainable investment that continues to develop Evidence-based treatment protocols

Programme weaknesses Inadequate funding given need (majority of smokers unaware of the NRT aspect) Lack of secure funding Relatively under-promoted & “Subsidised access to NRT” an under-used theme Pacific smokers under-represented (at 5.2%) Quitline promotion not synchronised with demand surge (eg, new smokefree law)

Summary Available evidence: Quitline and mass subsidisation of NRT are successful & cost-effective public health interventions in NZ. Funding is inadequate in terms of: need, likely demand (if adequately promoted), & demand at special times.

Acknowledgments Michele Grigg & Judy Li of The Quit Group for providing data & helpful comment. For funding support for conference attendance on a related topic: US National Institute on Drug Abuse, US National Cancer Institute, Robert Wood Johnson Foundation, National Heart Foundation of New Zealand.