Examination of witness (Questions 240
- 249)
THURSDAY 25 NOVEMBER
1999
MR CLIVE
BATES
240. If we accept it is about a powerful addiction,
I think we have also had evidence that nicotine replacement therapy
particularly when combined with other drugs can be very effective
in helping people to kick the habit, if I can use the word habit.
(Mr Bates) Yes.
241. I think in reply to an earlier question
from Simon Burns on voluntary agreements you implied that the
control of NRT therapy was probably more strict than the control
of additives to cigarettes.
(Mr Bates) Good grief, yes, yes.
242. Do you think that something needs to be
done to change the regulatory process in terms of NRT?
(Mr Bates) Yes. I would not want NRT to just simply
be declassified as pharmaceutical and just any old product you
put on the market but I do think it is an extremely cost effective
treatment for nicotine tobacco dependence. It is not available
on reimburseable prescriptions from the doctor, that is not the
intention anyway and that is an anomaly. It takes the companies
a long time to get their products approved. There are still unnecessary
contra indications and warnings on NRT packets that really miss
the point about what the product is for, it is there to help people
stop smoking, not as a drug that you would just use for the sake
of it. I think we have seen some relaxation of the regulatory
framework on NRT products but what we need to see is much greater
availability, especially through the NHS and on prescription.
It is a very good thing for the NHS to be spending its money on.
It is quite interesting in the context of NICE, which is evaluating
cost effectiveness, if it is to evaluate the nicotine replacement
products that are on the market today, which as a consumer you
have to purchase at the manufacturer's full price, it would very,
very likely I think recommend that those be made available through
the NHS on a reimburseable basis simply because the value of increasing
the quit rates for people trying to give up smoking are so great
in public health terms, in terms of all the avoidable health impacts
that happen further down the line, it makes it one of the most
cost effective treatments that there is available to the public,
yet it is not made available through ordinary prescriptions through
the doctor and that is something we would like to see changed.
Sadly, as things stand, NICE would not get to make an evaluation
of the cost effectiveness, it would only make evaluations of new
products coming on to the market.
243. Would your recommendation to us be that
we should suggest to NICE they ought to look at this?
(Mr Bates) Yes. I think it would be good. NICE will
have to consider a Glaxo Wellcome smoking cessation product, Zyban,
when and if it is approved for release in the UK early next year.
It is going through the regulatory process at the moment. All
the evidence is that will prove to be a very cost effective treatment
measured by any standards. If you look at the cost effectiveness
of things like statins or heart transplants or all the other things—
244. Presumably NICE would have to look at that
in comparison with the costs of other treatments?
(Mr Bates) That is right. I think it would make sense
when it made that assessment, in order not to discriminate against
manufacturers of one smoking cessation product versus another,
if NICE made a comprehensive assessment of all smoking cessation
products, nicotine replacement therapies and this Zyban, anti-depressant
smoking cessation treatment. If it did that then it would make
a consistent recommendation about the NHS expenditure on those
products. I am fairly confident if it does a fair assessment of
the cost effectiveness, as it did for the Relenza drug which it
recommended a rejection of, it would recommend that this would
be a good expenditure for NHS funds. The Secretary of State, having
taken NICE's advice very clearly in the case of Relenza, would
be in a difficult position about rejecting the advice to approve
a drug like that if NICE came out and recommended smoking cessation
therapies are made available free through the NHS or through the
normal prescription route.
245. Do you think that in doing that NICE—I
believe it should—should do that evaluation in the light
of non drug therapies as well? The evidence we have had is that
NRT on its own is effective but it is disproportionably more effective
when in combination with other therapies.
(Mr Bates) Yes. The best available research on this
suggests that NRT, all other things being equal, roughly doubles
the chance of making a successful quit. If that is just somebody
going to the pharmacy and buying it and gritting their teeth and
putting the patch on, then it is doubling from three per cent
to six per cent the quit rate, if it is being used in the context
of a smoking cessation clinic it is doubling from ten to 20 per
cent. The setting in which it is used is important but its impact
on the efficacy is roughly consistent across various settings.
Mr Amess
246. We have had the ballot of Private Member's
Bill today and I wonder if you are aware of any Member who is
going to present a Bill on your behalf?
(Mr Bates) I am not aware. What I have considered
doing is promoting the idea of—
Chairman
247. We have established that Mr Amess has been
successful, yet again.
(Mr Bates) Oh have you, right. Okay.
Mr Amess
248. I have already decided on my Bill, it is
a straight forward Bill to abolish the Labour and Liberal Parties.
(Mr Bates) I must admit you would not necessarily
be the obvious Member to approach on a tobacco advertising bill.
We have a back pocket strategy should the tobacco companies be
successful in their appeal to the courts or the Department of
Health be unsuccessful in their appeal against the judgment which
has put the advertising ban on hold. We thought and we got the
impression it would be possible to promote through a Private Member's
Bill primary legislation through the House that would ban tobacco
advertising. Given the new enlightened approach to tobacco that
we are seeing from the Conservative Party, I am sure it would
have all party support.
Chairman
249. He has always been very enlightened. Can
I thank you for your evidence. It has been very helpful. We are
most grateful to you.
(Mr Bates) I will follow up on that.
Chairman: Thank you.
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