What is the most effective way to discourage smoking?

What is the most effective way to discourage smoking? Chantix tablets? A support group? Nicotine patches? Or, how about sharply raising the price of cigarettes by jacking up the tax?

A new study compared the efficacy of the various methods in Israel for the first time, looking at medical efficacy and cost efficiency. The results are presented here in a ranked list.


The research team consisted of economist Dr. Gary Ginsburg and Dr. Eli Rosenberg of the Health Ministry, and Dr. Baruch Rosen of the Brookdale Institute. They based their work on international studies, adapted to Israel based on economic and demographic parameters.

The researchers factored in the cost of the various "rehabilitation" methods versus the potential savings to the state from a decrease in the number of nicotine addicts and the ensuing health problems.

The direct cost of smoking-related harm in Israel was NIS 1.75 billion in 2008, they say, or 0.25% of Israel's gross domestic product.

The team compiled two lists: One lists methods that save the state money. The other lists methods that may not achieve that end, but the methods in both lists have proved effective in helping people stop smoking.

The first contains methods that were found to be cost-effective, meaning they involve costs, but ultimately save the health system money.

These include raising the tax on cigarettes (which just happened, adding NIS 2 per pack of cigarettes), taking large doses of Champix tablets (2 milligrams a day), or drug therapy combined with a telephone hotline for quitters in crisis.

The second list includes methods that don't save the health establishment money. But they were found to be more cost-effective for the smoker: Each shekel invested in these methods had a considerable contribution to the health of both the actual smoker and his associates, who may suffer the effects of passive smoking. This list also contains Pfizer's Champix tablets, but at a lesser dosage of 1 milligram a day, as well as the drug Zyban. Nicotine patches also make this list, as did counseling.

In fact, Champix leads this second list. It is effective and can be cheaper than other methods. But the researchers stress that taking the tablets can have side effects. So, it works well, but it bears a risk that wasn't factored in when preparing the lists, explains Ginsburg. Champix, known in the United States as Chantix, works biochemically by blocking the nicotine molecule from binding to receptors in the brain. It reduces the desire to smoke, but can cause nausea, constipation or diarrhea, anxiety, flatulence, emotional upheaval, chest pain, vomiting, "changes in dreaming," and more. Some patients reportedly even experiences euphoria.

Pay today to save tomorrow

Would it pay for the state to "intervene" and help people stop smoking? The researchers calculated that the initial cost to the state of an intervention program would be NIS 478 million, and that it could be covered by raising the tax on cigarettes. They conclude that investing NIS 500 million in the right programs to help people stop smoking would save the state NIS 900 million in long-term outlays on smoking damage, so ultimately the state would save NIS 400 million. In terms of health, Israelis would gain 58,000 years of quality life.

However, they do understand that for policy-makers, it's hard to invest in programs that will only pay off after years.

"Usually, when allocating resources for health, care takes precedence over prevention, partly because they can see the patients right before them. Tomorrow's patients can't be seen and there's no pressure from them," says Ginsburg.

Based on the new findings, the researchers hope that preventative medicine, which is traditionally neglected in resource allocation in favor of actual treatments, will be taken more seriously.

"It's very important to finance open-heart surgery and to add drugs that would extend life for cancer patients even by a few weeks to the drugs basket. But research shows that prevention pays the best, economically and in terms of health," says Rosen.

Certainly he hopes that his present work will provide that necessary back-wind to prevention. The study provides actual figures for the vague assumption about "an ounce of prevention: it clearly shows the costs and future savings, and the benefits to health.

David and Goliath

Last week the Health Ministry released its first report of this nature, revealing a fact that cigarette manufacturers would probably have preferred to keep quiet.

Following a law that the Knesset passed a year ago, the companies were forced to reveal their spending on advertising and promotion. Thus we learn that the tobacco companies spent NIS 37.5 million on advertising in 2007.

It is true that the Israeli legislator has severely limited where the tobacco firms can promote their wares. Tobacco companies may not advertise on radio or television. They can advertise in the press, and cannot praise the virtues of smoking. They can't use models who are celebrities or who are less than 40 years old. They must include health warnings ("Smoking kills," for example), and each company cannot place more than one ad a day.

Yet the following statistic shows how the economic might of the tobacco companies threatens the anti-smoking campaign: The tobacco companies spent more than 25 times the anti-smoking advertising budget of the Israel Cancer Association and Health Ministry combined in 2007, the figures show.

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