Isabella Hornick , 2025-05-12 11:44:00
Key takeaways:
- Survey responses provided information on smoking cessation medications in pharmacies, health care facilities and central medicine stores.
- Availability was often low, and prices differed by facility type.
Across 60 low- and middle-income countries, health care professionals reported sparse availability and unaffordable prices of nicotine gum, nicotine patches and bupropion, according to findings published in Thorax.
“Our data can be used to inform smoking cessation programs in [low-income and middle-income countries (LMIC)], and combining this with other strategies will be key in achieving the greatest success for the individuals, as well as global targets in disease reduction,” Catherine Plum, of University Hospitals of Morecambe Bay NHS Trust in the U.K., and colleagues wrote.
Data were derived from Plum C, et al. Thorax. 2025;doi:10.1136/thorax.2024-222391.
In a cross-sectional study using data from 2022 to 2023, Plum and colleagues evaluated survey responses from health care professionals across 60 LMIC to determine availability, cost and affordability of three smoking cessation medications on WHO’s Model List of Essential Medicines — nicotine gum, nicotine patches and bupropion tablets — in pharmacies (57 countries represented), health care facilities (56 countries represented) and central medicine stores (46 countries represented) where they live.
The facility type with the highest availability of 2 mg to 4 mg nicotine gum was pharmacies (20 out of 57), followed by health care facilities (5 out of 56) and central medicine stores (4 out of 46). This pattern was also true for 1 mg to 21 mg nicotine transdermal patches, as researchers reported more pharmacies had this medication available (13 out of 57) compared with health care facilities (6 out of 56) and central medicine stores (5 out of 46).
Notably, there was low availability of 150 mg bupropion tablets across all facilities, with only two of each facility type having this medication, according to the study.
When assessing the median cost of nicotine gum in U.S. dollars, researchers observed the highest price tag in pharmacies at $96. Central medicine stores and health care facilities had lower costs ($65.72 and $61.94, respectively).
Health care facilities had the highest median cost for nicotine patches at $68.61, according to the study. Pharmacies followed at $62.09, and central medicine stores had the lowest cost at $43.72.
For bupropion tablets, researchers only had data on costs from pharmacies and health care facilities, and the former had a higher price tag (median, $143.89 vs. $25.10).
In terms of affordability, the study determined this based on whether “1 month’s treatment cost less than 1 day’s wage of the lowest paid government worker, defined by local minimum wage.”
According to this classification, nicotine gum was unaffordable in the 19 pharmacies, five health care facilities and two central medicine stores that had information on costs for this medication. Similarly, in the two pharmacies and two health care facilities with price information for bupropion, the tablets were deemed unaffordable by researchers.
Out of the 13 pharmacies, five health care facilities and three central medicine stores with price information for nicotine patches, the study noted that only one pharmacy offered this medication at an affordable price.
“Everyone globally should have the best support in stopping smoking, but without medications chances of successful smoking cessation are reduced,” Plum and colleagues wrote.
Perspective
The efficacy of three classes of smoking cessation medications – nicotine replacement, which has several effective formulations, bupropion and varenicline – is well-established. These medications improve quitting, doubling or, in the case of varenicline, more than doubling the number of individuals attempting to quit who achieve abstinence.
Importantly, smoking should be regarded as a chronic relapsing disease. In this context, each successful abstinence represents a remission. Relapses are not “failures” but are expected and retreatment is well-documented to help achieve another remission. Use of the most effective available therapy to induce remission and to treat relapses is the most desirable therapy.
Smoking is one of the most important preventable causes of disease worldwide. It has become an increasingly important problem in low- and middle-income countries. The study by Plum and colleagues highlights a major problem in addressing the health impacts of smoking. No medicine is effective if not taken.
Unfortunately, there is limited availability of some smoking cessation medications and nearly uniform lack of affordability in low- and middle-income countries. This is a problem that should be a high priority for the international public health community.
This has some limitations. Data were available from only selected countries and from limited pharmacies within those countries. However, the striking findings from the data available provide considerable confidence that the problem of lack of availability and affordability is real.
What is unclear about the problem identified by Plum and colleagues is what should be done. There is no discussion for the basis of the costs of the medications. There is no discussion of whether the international public health community is in a position to address the problems identified. There is also no discussion of the cost-effectiveness of smoking cessation medications in low- and middle-income countries. While the cost-effectiveness in high-income countries is well-established, these data may not be generalizable.
In summary, a major problem has been identified by Plum and colleagues. It is a problem that suggests further action, which may have substantial challenges and require considerable advocacy.
Stephen Rennard, MD
Disclosures: Rennard reports having or will be receiving honoraria for consulting, speaking or support for travel from the Alpha-1 Foundation, Arrowhead, CSL, Galvanize, GOLDCOPD, the NIH, Regeneron, RespirAI, Roche, RS Biotherapeutics and Sanofi within the last year.
Sources/Disclosures
Collapse
Disclosures:
One author reports receiving advisory board fees from AstraZeneca and GSK. All other authors report no relevant financial disclosures.
