Making smoking policy


Doing simple things well can have a large impact at low cost. Having evidence-based policy might be better than policy-based evidence.


MK Ong, SA Glantz. Free nicotine replacement therapy programs vs implementing smoke-free workplaces: a cost-effectiveness comparison. American Journal of Public Health 2005 95: 969-975.


Stopping people smoking is a campaign that seems to be paying off in developed countries. There is a general consensus that smoking is a bad thing, which is always a good place to start. Also there are more restrictions on smoking (planes, trains, restaurants, theatres etc), and some places (New York, Ireland) ban smoking in public places.

Arguments now rage about stopping all smoking in public places, especially the workplace. This seems a sensible thing to do, and most professionals would like to see it as a policy. A competing policy, or at least a parallel policy, is one of a free NRT programme. Which would be best?

Bandolier has a prejudice, in that it introduced smoke-free workplaces 20 years ago. It also had concerns over the efficacy of NRT, or at least the evidence of efficacy.

A study models these two strategies in the US State of Minnesota, with an estimated smoker population of 825,000 people. It uses sensible and conservative estimates from reasonable sources of evidence.


The main results of the simulations conducted are in Table 1. It shows that a smoke-free workplace policy would cost little and would deliver substantial numbers of quitters at little cost. Free NRT would produce more quitters, but at substantially greater cost. Free NRT would be about 10 times more expensive per quitter or QALY.

Table 1: Results of simulations

Smoke-free workplace
Free NRTprogramme
Induced quitters
Cost, US$ million
Cost per quitter US$
Cost per QALY US$



Of course, there are more details than this in the paper, and various assumptions were tested. But the main findings were pretty much the same. What is particularly interesting is that this US Public Health journal carries this paper in a section called "Building capacity and evaluating strategies", concepts that are less common to some parts of the world with more socialised healthcare systems.