OBJECTIVES

: At the end of 2017, the French ministry of health decided to allow the reimbursement of nicotinic substitute to reduce tobacco smoking. Before this decision, patients could only benefit from a fixed €150 per-year reimbursement basis to cover nicotinic substitute expenses (patches and gum). The aim of this study was to evaluate the budget impact of the nicotinic substitute reimbursement on the French social security.

METHODS

: Three types of scenarios were considered: the first scenario was the situation before the ministry’s decision (€150 maximum to cover medicines expenses), the second scenario took into account the reimbursement of only one form of nicotinic substitutes. In the third scenario, all nicotinic substitutes (oral and transdermal) were reimbursed. Hypothesis of population growth were function of the chosen scenario.

Based on the price cut observed for NicoretteSkin (patch), a single price cut of 35.8 % was applied on the nicotinic substitute price.

RESULTS

: The budget impact of scenario 1 was estimated for the social security system around €116.5 M for four years (2018-2021). Scenario 3, in which all forms of nicotinic substitutes were reimbursed, was the worst case scenario, with a budget impact of €191 M.

Scenario 2a in which only patches were reimbursed was the best case scenario: French social security would save €76 M compared to scenario 1. Scenario 2b with only oral forms reimbursed had a budget impact similar to scenario 1 (around €115 M).

Moreover, similar measures in other countries (Netherlands, Quebec), after a couple of years, had a neutral effect on the number of smokers.

CONCLUSIONS

: Allowing the reimbursement of all forms of nicotinic substitutes (oral and transdermal) will involve a huge increase in spending for French social security because the increase of population will not be compensated by price cuts.