Evaluation of smoking cessation drug use and outcomes in the Netherlands

Abstract

Objective:

Several pharmacological therapies are available to help smokers quit. The aim was to investigate the utilisation and effectiveness of smoking cessation drugs in daily practice in the Netherlands.

Methods:

Subjects aged ≥18 years with a pharmacy prescription of varenicline, bupropion, nicotine replacement therapy (NRT) or nortriptyline between March 2007 and September 2008 were identified from the PHARMO data warehouse, which includes drug dispensing, hospitalisation and other data from approximately 2.5 million residents in the Netherlands. Using an encrypted methodology, corresponding non-person-identifiable dispensing IDs were linked to a web-based system for patient-reported data collection. Corresponding pharmacists asked the subjects to participate in the study and complete a web-based questionnaire on smoking history and cessation, including utilisation of (pharmaco) therapies.

Results:

Of 2,684 invited subjects, 698 responded (26%), of whom 612 were included in the analyses. Bupropion was the most frequently used smoking cessation drug (35% of patients), followed by varenicline (28%), bupropion + NRT (12%) and varenicline + NRT (9%). Overall, 51% of patients also reported behavioural therapy. A total of 53% of bupropion users, 51% of varenicline users, 42% of NRT users and 20–40% of patients using multiple drugs reported to not smoke at the time of questionnaire. Median (interquartile range) number of days between time of questionnaire and start date of last quit attempt ranged from 271 (104–432) for varenicline + bupropion to 356 (205–518) for bupropion. Mean duration of drug use ranged from 42 to 53 days among quitters and from 19 to 42 days among relapsers.

Conclusion:

In this study up to 50% of patients who obtained smoking cessation drugs at the pharmacy stopped smoking. Better access to smoking cessation drugs as recommended in guidelines will help to further decrease smoking prevalence.

Key words::

• Daily practice
• Effectiveness
• Smoking cessation drugs
• Utilisation

Transparency

Declaration of funding

This study was financially supported by an unrestricted grant from Pfizer B.V., the Netherlands. No limitations were set with regard to the conduct of the study and the writing of the manuscript.

Declaration of financial/other relationships

The PHARMO Institute received financial support from Pfizer to conduct this study. Fernie Penning-van Beest, Jetty Overbeek, Maartje Smulders and Ron Herings are employees of the PHARMO Institute, which received payment from Pfizer in connection with the development of this manuscript. Willem Jan Meerding was an employee of Pfizer at the time of study and manuscript development.