Sustainable Policy: Higher Medication Use & Adherence During Reimbursement of Pharmacologic Smoking Cessation Treatments.

Background: The discussion on the reimbursement of Smoking Cessation Treatment (SCT) has known many stages in The Netherlands. From January 2011, SCTs were reimbursed, until January 2012 when the reimbursement of nicotine replacement therapies (NRTs) and pharmacotherapeutic SCT (pSCT) was discontinued. As of 2013, NRTs and pSCTs were again reimbursed for a maximum of one attempt per calendar year, provided they are accompanied by behavioural counselling. Objectives: To assess the impact of changes in reimbursement policy of pSCT on use and adherence. Methods: A retrospective dispensing database analysis was performed on real-world observational data from the years 2010-2013 in The Netherlands. Data on use and adherence was collected, in patients who were dispensed bupropion or varenicline in community pharmacies for the first time. Adherence was defined a using minimal 80% of the in guidelines recommended duration and intensity of use. Results: The study cohort consisted of 4,412 users of pSCT. The number of prescriptions was stable at 0.5 prescriptions per 1,000 inhabitants (dispensing prevalence, dp) during 2010. The prevalence was on average 0.8 dp, with peaks in the the 1st and 4th quarters of 2011. In 2012, the prevalence was stable at 0.4 dp. In 2013 was on average 0.5 dp, with a small peak in the 1st quarter. Adherence was 18% in 2010 and 2012 (non-reimbursement period), and 21% in 2011 and 2013 (reimbursement period). Conclusions: Not only the likelihood of starting smoking cessation, but also the extent of adherence to pharmacologic smoking cessation is higher during reimbursement. Increasing the awareness of health care providers on adherence issues is warranted.