Positive effects from the introduction of fully subsidised nicotine replacement therapy in Ireland

Abstract Smoking remains a leading cause of preventable death in the Europe. Despite recent declines in prevalence, the adverse health and economic effects of smoking are felt disproportionately by disadvantaged groups. Nicotine replacement therapy (NRT) is well established as an effective smoking cessation aid; however, its financial cost may act as a barrier to uptake. In February 2023, eligibly for fully subsidised NRT was expanded to all users of smoking cessation services in Ireland. This study evaluated the impact of universal access to NRT on smoking cessation. This study utilised secondary analysis of routinely collected data from service users attending Irish smoking cessation services. Individuals were followed for twelve weeks. Changes in self-reported quit status and NRT use were analysed before (January 2021 - February 2023) and after (March 2023 - December 2023) the introduction of fully subsidised NRT. Logistic regression modelling identified factors associated with smoking cessation. The total number of participants was 19,717. There was higher uptake of NRT among service users who were eligible for free NRT (59% vs 40%, p < 0.001) and higher quit rates at four (41% vs 29%, p < 0.001) and twelve (29% vs 20%, p < 0.001) weeks. Logistic regression models demonstrated that NRT use was significantly associated with smoking cessation at four (aOR 1.88, 95%CI 1.47 - 2.41) and twelve (aOR 1.76, 95%CI 1.37 - 2.28) weeks. This study confirms the effectiveness of NRT in an Irish context and illustrates the benefits of universal access to this life saving medicine. Targeted interventions are required to intensify services offered to disadvantages groups if the ambitious objectives of Tobacco Endgame are to be achieved. These findings represent an urgent call to action for European policy makers to deliver equitable access to NRT across the continent. Such action can transform the public health landscape and help bring us closer to achieving a tobacco free Europe. Key messages • This study confirms the real-world effectiveness of NRT use as a smoking cessation aid. • The removal of financial barriers is associated with increased NRT use and successful smoking cessation.