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. 2025 Mar 21;25(1):417.
doi: 10.1186/s12913-025-12533-y.

The budget impact analysis of nicotine replacement therapy among patients who smoke tobacco and have mental illness in South Africa and the implications

Basetsana Maphanga  1 , Moliehi Matlala  1 , Rajesh Vagiri  2 , Brian Godman  3   4 , Letlhogonolo Makhele  5
Affiliations

The budget impact analysis of nicotine replacement therapy among patients who smoke tobacco and have mental illness in South Africa and the implications

Basetsana Maphanga et al. BMC Health Serv Res. .

Abstract

Background: Tobacco use is the world's leading preventable cause of death, with the highest burden in low and middle-income countries (LMICs). Those who have mental illness are particularly vulnerable, with a smoking rate two to five times higher than that of the general population. Quitting smoking has demonstrated benefits for mental health, including reducing stress and improving the quality of life. However, the economic feasibility of introducing Nicotine Replacement Therapy (NRT) in the psychiatric medical environment in South Africa has not yet been explored. This study aims to address this gap by assessing the impact on the budget of implementing an NRT-based smoking cessation program in a psychiatric hospital.

Methods: This retrospective and cross-sectional study followed a budget impact analysis framework. Data were retrieved between May 19 and Aug 18, 2023, from 214 patients' medical records. Using primary and secondary data, an ingredients costing approach was used to estimate direct treatment costs of NRT smoking cessation. All costs were expressed in ZAR (South African currency). The economic evaluation was conducted from the payer's perspective, and the results were reported at a 5% discount rate. A two-way 10% sensitivity analysis was conducted.

Results: The study showed that study participants were primarily black, male, unemployed, diagnosed with schizophrenia and smoked lightly (69.16% ±3.46). Implementing the 3-month treatment period of NRT smoking cessation program would result in an expenditure of R1 478 915.42 for 214 patients. The hospital will require an additional 0.15% (±0.0095) of the total hospital budget and 6.09% (±0.31) of the hospital pharmacy budget.

Conclusion: Our findings indicate that while implementing a NRT is crucial for improving the overall health outcomes among patients with mental illnesses, substantial investment would be required. The budgetary allocation for NRT smoking cessation interventions would vary by treatment settings and program duration. Consequently, careful consideration of budget allocation and resource distribution is necessary to ensure the program's sustainability within the broader healthcare framework in South Africa.

Keywords: Budget impact analysis; Mental health; Nicotine replacement therapy; Psychiatric hospitals; Smoking cessation; South Africa.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in full compliance with the Declaration of Helsinki ( https://www.wma.net/policies-post/wma-declaration-of-helsinki/ ) [72]. Ethical clearance and approval were obtained from the Sefako Makgatho University Research and Ethics Committee (SMUREC), application SMUREC/P/168/2023: PG and the University of Pretoria Faculty of Health Sciences Research Ethics Committee, application 11/2023. The study made use of patients’ records and anonymization was applied throughout the data collection period. No communication was done with the patients; hence, patient consent was not required. In this case, we used the hospital approval process governed by Guidelines for Good Practice in the Conduct of Clinical Trials with Human Participants in South Africa [73]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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Sensitivity Analysis
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References

    1. WHO. Tobacco. 2023 Available at URL: https://www.who.int/news-room/fact-sheets/detail/tobacco.
    1. Le Foll B, Piper ME, Fowler CD, Tonstad S, Bierut L, Lu L, et al. Tobacco and nicotine use. Nat Reviews Disease Primers. 2022;8(1):19. - PubMed
    1. Spatial temporal. Demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the global burden of disease study 2019. Lancet. 2021;397(10292):2337–60. - PMC - PubMed
    1. 2021-Global-Adult-Tobacco-Survey-South-Africa-Report-Launched-13-June-2024_compressed-1-1 (1). (n.d.).
    1. Groenewald P, Pacella R, Sitas F, Awotiwon OF, Vellios N, Van Rensburg CJ, et al. Estimating the changing disease burden attributable to smoking in South Africa for 2000, 2006 and 2012. S Afr Med J. 2022;112(8b):649–61. - PubMed

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