1. Richard Sekula Head of PH Intelligence NHS Greenwich

2. Purpose:  To estimate the impact of additional investment into Stop Smoking Service on NHS Greenwich budget  Joint initiative of Public Health and Finance Directorates  Matrix Knowledge Group – commissioned to support economical evaluation and modelling

3. Key problems:  Smoking-related costs to NHS Greenwich  Impact of reduction in smoking prevalence – achieved by stop smoking service – on NHS Greenwich budget  Costs of delivering long-term reduction in smoking prevalence

4. NHS Greenwich: Smoking-related costs  NHS IC: Statistics on Smoking, 2009; to define smoking-attributable admissions for adults aged 35+  Assumption: fraction of CVD admissions attributable to smoking = fraction of PB cat 10 (CVD) attributable to smoking  Smoking costs modelled only on 25% of total NHS Greenwich budget – PB cat. 2, 10, 11, 13 and 16  Estimated annual costs of smoking = £9.5 m

5. Reduction in smoking prevalence: impact on NHS Greenwich budget  1% reduction in smoking prevalence ≠ 1% reduction in smoking-related costs  Reduction in risk of developing smoking-attr. disease depends on age at quitting smoking and disease category (i.e. risk of lung cancer decreases 5-10 years after quitting smoking, risk of CVD event decreases significantly within weeks from quitting smoking)  Cancer costs removed from modelling

6. Reduction in smoking prevalence: impact on NHS Greenwich budget Estimated no of smokers in Greenwich Age rangeMalesFemales <3592668016 35-4450244641 45-5434653513 55+32663714 total2102019885 Source: ONS, GHS England, 2007 Effects on mortality* Stopping smoking at age:MalesFemales <35100% 35-4490% 45-5460% 55+30% *- 100% = mortality rate identical to non-smokers Source: Doll R., Peto R., et al: Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ, 2004

7. Costs of delivering long-term reduction in smoking prevalence  Unclear links between short-term quitters (at 4 weeks) and long-term quitters (est. from 25-50% of 4 weeks quitters)  NHS Greenwich Smoking Cessation Service (GSCT): delivering additional 2% annual reduction in long-term smoking prevalence would require investment of £450k

8. “Can you really save money with this?” Costs of smoking were modelled based on 2007/08 costs of 10,11,and 13 programme budgeting categories Costs with 2% reduction include costs of delivering interventions by NHS Greenwich Smoking Cessation Team Yes, but not as fast as you’d like

9. What could support stop smoking investment?  Emphasis on health outcomes  Linking more PB categories’ spend with smoking  Modelling of impact on joint Health and Social Care budgets

10. Problematic trends  Whilst smoking prevalence is decreasing, smoking attributable admissions are rising nationally and locally