Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development

Article English OPEN
West, Robert ; Raw, Martin ; McNeill, Ann ; Stead, Lindsay ; Aveyard, Paul ; Britton, John ; Stapleton, John ; McRobbie, Hayden ; Pokhrel, Subhash ; Lester-George, Adam ; Borland, Ron (2015)
  • Publisher: Wiley
  • Journal: volume 110, issue 9, pages 1,388-1,403 (issn: 0965-2140, eissn: 1360-0443)
  • Related identifiers: doi: 10.1111/add.12998/abstract, doi: 10.1111/add.12998/abstract?system, doi: 10.1111/add.12998, pmc: PMC4737108
  • Subject: Effectiveness | Medicine (miscellaneous) | National guideline development | Healthcare interventions | Brief interventions | Cytisine | Efficacy | Affordability, NRT, behavioural support, brief interventions, cytisine, effectiveness, efficacy, interventions, smoking cessation, tobacco cessation | Affordability | Psychiatry and Mental health | NRT | /dk/atira/pure/subjectarea/asjc/2700/2738 | Tobacco cessation | Interventions | Smoking cessation | Monograph | Behavioural support | /dk/atira/pure/subjectarea/asjc/2700/2701

Aims: This paper provides a concise review of the efficacy, effectiveness and affordability of health-care interventions to promote and assist tobacco cessation, in order to inform national guideline development and assist countries in planning their provision of tobacco cessation support. \ud \ud Methods: Cochrane reviews of randomized controlled trials (RCTs) of major health-care tobacco cessation interventions were used to derive efficacy estimates in terms of percentage-point increases relative to comparison conditions in 6–12-month continuous abstinence rates. This was combined with analysis and evidence from ‘real world’ studies to form a judgement on the probable effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on World Health Organization (WHO) criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of saving a life-year was less than or equal to the per-capita gross domestic product for that category of country. \ud \ud Results: Brief advice from a health-care worker given opportunistically to smokers attending health-care services can promote smoking cessation, and is affordable for countries in all World Bank income categories (i.e. globally). Proactive telephone support, automated text messaging programmes and printed self-help materials can assist smokers wanting help with a quit attempt and are affordable globally. Multi-session, face-to-face behavioural support can increase quit success for cigarettes and smokeless tobacco and is affordable in middle- and high-income countries. Nicotine replacement therapy, bupropion, nortriptyline, varenicline and cytisine can all aid quitting smoking when given with at least some behavioural support; of these, cytisine and nortriptyline are affordable globally. \ud \ud Conclusions: Brief advice from a health-care worker, telephone helplines, automated text messaging, printed self-help materials, cytisine and nortriptyline are globally affordable health-care interventions to promote and assist smoking cessation. Evidence on smokeless tobacco cessation suggests that face-to-face behavioural support and varenicline can promote cessation.
  • References (82)
    82 references, page 1 of 9

    1. Doll R., Peto R., Boreham J., Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 2004; 328: 1519.

    2. Pirie K., Peto R., Reeves G. K., Green J., Beral V., Collaborators M. W. S. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2013; 381: 133-41.

    3. Ebbert J., Montori Victor M., Erwin Patricia J., Stead L. F. Interventions for smokeless tobacco use cessation. Cochrane Database Syst Rev [internet]. 2011; (2). Available at: http:// www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004306/frame.html (accesed June 25 2015).

    4. West R. The clinical significance of 'small'effects of smoking cessation treatments. Addiction 2007; 102: 506-9.

    5. All Party Parliamentary Group on Smoking and Health. Inquiry into the effectiveness and cost-effectiveness of tobacco control. London: Action on Smoking and Health; 2010.

    6. Parrott S., Godfrey C. Economics of smoking cessation. BMJ 2004; 328: 947-9.

    7. Fiore M., Jaen C. R., Baker T. B., Bailey W. C., Benowitz N. L., Curry S. J. et al. Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: US Department of Health and Human Services; MD2008.

    8. Ministry of Health New Zealand Smoking Cesssation Guidelines. Wellington: Ministry of Health; 2007.

    9. National Institute for Health and Clinical Excellence (NICE) NICE Public Health Guidance 10. Smoking Cessation Services in Primary Care, Pharmacies, Local Authorities and Workplaces, Particularly for Manual Working Groups, Pregnant Women and Hard to Reach Communities. London: NICE; 2008.

    10. Leaviss J., Sullivan W., Ren S., Everson-Hock E., Stevenson M., Stevens J. W. et al. What is the clinical effectiveness and costeffectiveness of cytisine compared with varenicline for smoking cessation? A systematic review and economic evaluation. Health Technol Assess 2014; 18: 1-120.

  • Metrics
    No metrics available
Share - Bookmark