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Effective smoking cessation support/treatment includes a range of interventions.



There is now compelling evidence showing that treatment of tobacco dependence is both effective and cost-effective across a wide range of settings (Cromwell et al., 1997; Fiore et al., 2008; Parrott et al., 1998; Raw et al., 1998; Raw et al., 2002; West et al., 2000; Woolacott et al., 2002; see also Efficacy section).

Population-based versus Clinic-based Approaches: Population-based approaches include helplines, GP advice and self-help materials (National Cancer Institute, 2000; Novotny et al., 2000) and although they are associated with lower success rates, they have the potential to reach a greater number of smokers. In particular, the effectiveness of telephone quit lines and counseling services can be increased when combined with pharmacotherapy (Cummings et al., 2006; Shearer & Shanahan 2006).  In contrast, more intensive treatment approaches, including smoking cessation clinics, have higher success rates but reach fewer smokers, so their population impact is smaller. Nevertheless, these approaches are highly cost-effective health care interventions (Parrot et al., 1998). The diagram below (Ref: UK Department of Health, Choosing Health, 2004, page 132) indicates the different reach of a few selected different cessation methods in the UK.



Brief Intervention. A priority of any smoking cessation treatment strategy should be the routine provision of brief advice and follow up in primary care including advice on effective pharmacological treatments. Routine tobacco cessation advice and support should be given by health professionals, including physicians, health practitioners, nurses, pharmacists, community workers and social workers based in primary and secondary care. Brief advice appears to have its effect by triggering increased numbers of quit attempts and increasing the chances of success of quit attempts. The US Public Health Service Clinical Practice Guideline (Fiore et al., 2008) states that "minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates." The pooled OR of cessation is 1.3 (95% CI=1.01-1.6) for brief counseling (<3 min), 1.6 (95% CI=1.2-2.0) for low intensity counseling (3-10 min) and 2.3 (95% CI=2.0-2.7) for higher intensity counseling (>10 min) (Fiore et al., 2008). The 2005 Cochrane review on individual counseling also finds that cessation counseling can assist smokers to quit, and does not define whether the success comes from increased quit attempts or success on a particular try at quitting (Lancaster & Stead 2005). Brief advice should also be backed up by the provision of specialist intensive support for those that need it.

Pharmacological Interventions. Pharmaceutical products such as nicotine replacement therapy (NRT), bupropion and varenicline, have also been found to be effective treatments for smoking cessation (see Efficacy section). NRT has been shown to be effective in an over-the-counter (OTC)-like setting with no additional instruction or support (Fiore et al., 2008; Hughes et al., 2003) though the absolute quit rates are higher when pharmacological and behavioral treatments are combined. An international review of the cost-effectiveness of pharmaceutical products for cessation by Cornuz et al (2006) found that these therapies compared favorably with other preventive interventions.

All of the above approaches are complementary and a comprehensive smoking cessation strategy should include a combination of as many as possible.



Cornuz J, Gilbert A, Pinget C, et al. Cost-effectiveness of pharmacotherapies for nicotine dependence in primary care settings: a multinational comparison. Tob Control. 2006; 15(3): 152-159.

Cromwell J, Bartosch WJ, Fiore MC, et al. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research. JAMA. 1997; 278: 1759-1766.

Cummings KM, Fix B, Celestino P, et al. Reach, efficacy, and cost-effectiveness of free nicotine medication giveaway programs. J Public Health Manag Pract. 2006; 12(1): 37-43.

Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

Hughes JR, Shiffman S, Callas P, Zhang J. A meta-analysis of the efficacy of over-the-counter nicotine replacement. Tob Control. 2003; 12(1): 21 27.

Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews. 2005; 2.

National Cancer Institute. Population based smoking cessation: proceedings of a conference on what works to influence cessation in the general population. Smoking and Tobacco Control Monograph No. 12. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute. NIH Publication No. 00-4892 . 2000.

Novotny TE, Cohen JC, Yurekli A, Sweanor D, de Beyer J. Smoking cessation and nicotine replacement therapies. In: Tobacco Control in Developing Countries. Edited by Prabhat Jha & Frank Chaloupka. Oxford: Oxford University Press. 2000.

Parrott S, Godfrey C, Raw M, West R, McNeill A. Guidance for commissioners on the cost-effectiveness of smoking cessation interventions. Thorax. 1998; 53(Suppl.5, Part 2): S1-S38.

Raw M, McNeill A, West R. Smoking cessation guidelines and their cost-effectiveness. Thorax. 1998; 53(Suppl.5, Part 1): S1-S19.

Raw M, Anderson P, Batra A, Dubois G, Harrington P, Hirsch A, Le Houezec J, McNeill A, Milner D, Poetschke Langer M, Zatonski W. WHO Europe evidence based recommendations on the treatment of tobacco dependence. Tob Control. 2002; 11(1): 44-46.

Shearer J, Shanahan M. Cost effectiveness analysis of smoking cessation interventions. Aust N Z J Public Health. 2006; 30(5): 428-434.

Stapleton J. Cost effectiveness of NHS smoking cessation services. London: ASH. 2001.

UK Department of Health. Choosing Health: Making healthy choices easier. Cm 6374. HM Government, London, 2004.

West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Thorax. 2000; 55(12): 987-999.

Woolacott NF, Jones L, Forbes CA, Mather LC, Sowden AJ, Song FJ, Raftery JP, Aveyard PN, Hyde CJ, Barton PM. The clinical effectiveness and cost-effectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation. Health Technol Assess. 2002; 6(16): 1-245.

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