To the Editor.
—In a well-designed and thoughtful analysis, Drs Fiscella and Franks1 determine the incremental costeffectiveness of the transdermal nicotine patch for smoking cessation as an adjunct to physician counseling. The authors conclude that their findings support both the use of the nicotine patch and health insurance coverage of patch therapy. We heartily endorse these conclusions. The authors also conclude that their analysis does not support over-the-counter (OTC) use of the patch since their model was insensitive to incremental changes in physician time. We respectfully question this conclusion. The only costs considered in the authors' analysis, those of patch and physician counseling, would be nil with OTC use for anyone obtaining patches without physician counseling. Thus, from the perspective of the medical payer used in their model, patch use would become highly costeffective, even if patch effectiveness were found to be significantly lower with OTC use.The key
McNagny SE, Ahluwalia JS. Use of Over-the-Counter Nicotine Patch for Smoking Cessation: Prudent or Premature?. JAMA. 1996;276(5):371. doi:10.1001/jama.1996.03540050031012