1. ©LTPHN 2008 Smoking Speaker name, affiliation,etc

2. ©LTPHN 2008 Smoking in London There are 2 million smokers in London Every ten minutes somebody is admitted to hospital due to smoking Every 50 minutes someone is killed by tobacco Every day the NHS in London spends nearly £300,000 on in patient treatment for smoking caused illness.

3. ©LTPHN 2008 Who is at the greater risk?

4. ©LTPHN 2008 Key Concepts Prevalence Incidence Mortality Risk

5. ©LTPHN 2008 The Patient SJ 48 y/o man 20min h/o crushing central chest pain –ECG –Angiogram –CABG Smoker, 20 cigarettes/day for 30 years

6. ©LTPHN 2008 Cost of Smoking What is the cost of CABG? –£20,000 How much has this man spent on cigarettes to date? –£50,000 What is his excess cost in lost productivity and extra sickness absence to date from smoking? –£20,000 On average, the excess cost to the economy of a smoker is £2000 per annum… without even considering passive smoking.

7. ©LTPHN 2008 Cost Effectiveness What is the cost of CABG per healthy year of life added? –£18,830 What is the cost of smoking cessation therapy per year of healthy life added? – £270 How many people could you give an extra year of healthy life to through smoking cessation therapy for the same price as saving a year of healthy life for one person through a CABG? –70 people (even if only 5% of those advised actually quit). If every smoker were given smoking cessation advice, and they all quit, each year of life saved would cost only a few pounds.

8. ©LTPHN 2008 Clinical Effectiveness How many years does CABG add to life? –0.6 years (about 7 months) What about stopping smoking? –8-10 years (28-34 years if high risk of CHD) How many people do you need to give smoking cessation advice to to stop one person from smoking? –20 Every second person you give smoking cessation advice to will live one year extra!

9. ©LTPHN 2008 Key Concepts Externalities Cost Utility Analysis QALY Cost per QALY NNT

10. ©LTPHN 2008 Further Information Department of Health Smoke free England 2007 Smoke free bars 2008 Other related policy www.dh.gov.uk/en/Publichealth/Healthimprovement/Tobacco/index.htm London Health Observatory www.lho.org.uk/HIL/Lifestyle_And_Behaviour/Smoking.aspx World Health Organisation www.who.int/topics/tobacco/en/ ©LTPHN Original author: Steve Hajioff. Last updated Aug 2008