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Rubaiya Talukder S, Lappin J, Clare Boland V, Weaver N, McRobbie H, James Courtney R. Mental health related adverse events of cytisine and varenicline in smokers with and without mental health disorders: Secondary analysis of a randomized controlled trial. Addict Behav 2024; 159:108148. [PMID: 39213816 DOI: 10.1016/j.addbeh.2024.108148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Little is known about the adverse events (AEs) of cytisine versus varenicline among individuals with mental health disorders (MHDs), highlighting the necessity for further exploration to inform clinical practice. This secondary analysis of clinical trial data aimed to investigate the effect of varenicline vs. cytisine regarding mental-health-related AEs (MH-related AEs) on smokers with and without MHDs. METHODS Australian daily smokers interested in quitting were randomised to varenicline (84 days) or cytisine (25 days) and categorised by self-reported MHD diagnosis or treatment in the past year (MHD or non-MHD groups). Treatment adherence was assessed by self-reported number of doses taken during the active treatment phase via two check-in calls (at one month), while AEs were evaluated through four phone interviews: two check-in calls (one month) and follow-up calls at four and seven months. Logistic regression analysis compared MH-related AEs between groups, including only participants taking at least one dose. RESULTS Of 1452 smokers 246 reported MHDs, 725 received cytisine and 727 received varenicline. Median number of doses taken was comparable between MHD (34 cytisine and 12 varenicline) and non-MHD (33 cytisine and 13 varenicline) groups. MH-related AEs were: 14.1 % (n = 30) in MHD (12.5 % in cytisine and 15.4 % in varenicline), and 11.8 % (n = 126) in non-MHD group (10.9 % in cytisine and 13.7 % in varenicline). No significant difference in MH-related AE occurrence was identified between medication groups (aOR=0.96, 95 % CI 0.4 to 2.2, p-value = 0.94). CONCLUSION Comparable MH-related AEs were observed between smokers with and without MHDs, suggesting that cytisine, like varenicline, may be well-tolerated by those with MHDs. However, larger clinical trials focused on MH-related AEs are needed for more conclusive evidence.
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Affiliation(s)
- Saki Rubaiya Talukder
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia.
| | - Julia Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney 2200, Australia
| | - Veronica Clare Boland
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia
| | - Ryan James Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia
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Perski O, Kale D, Leppin C, Okpako T, Simons D, Goldstein SP, Hekler E, Brown J. Supervised machine learning to predict smoking lapses from Ecological Momentary Assessments and sensor data: Implications for just-in-time adaptive intervention development. PLOS DIGITAL HEALTH 2024; 3:e0000594. [PMID: 39178183 PMCID: PMC11343380 DOI: 10.1371/journal.pdig.0000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/28/2024] [Indexed: 08/25/2024]
Abstract
Specific moments of lapse among smokers attempting to quit often lead to full relapse, which highlights a need for interventions that target lapses before they might occur, such as just-in-time adaptive interventions (JITAIs). To inform the decision points and tailoring variables of a lapse prevention JITAI, we trained and tested supervised machine learning algorithms that use Ecological Momentary Assessments (EMAs) and wearable sensor data of potential lapse triggers and lapse incidence. We aimed to identify a best-performing and feasible algorithm to take forwards in a JITAI. For 10 days, adult smokers attempting to quit were asked to complete 16 hourly EMAs/day assessing cravings, mood, activity, social context, physical context, and lapse incidence, and to wear a Fitbit Charge 4 during waking hours to passively collect data on steps and heart rate. A series of group-level supervised machine learning algorithms (e.g., Random Forest, XGBoost) were trained and tested, without and with the sensor data. Their ability to predict lapses for out-of-sample (i) observations and (ii) individuals were evaluated. Next, a series of individual-level and hybrid (i.e., group- and individual-level) algorithms were trained and tested. Participants (N = 38) responded to 6,124 EMAs (with 6.9% of responses reporting a lapse). Without sensor data, the best-performing group-level algorithm had an area under the receiver operating characteristic curve (AUC) of 0.899 (95% CI = 0.871-0.928). Its ability to classify lapses for out-of-sample individuals ranged from poor to excellent (AUCper person = 0.524-0.994; median AUC = 0.639). 15/38 participants had adequate data for individual-level algorithms to be constructed, with a median AUC of 0.855 (range: 0.451-1.000). Hybrid algorithms could be constructed for 25/38 participants, with a median AUC of 0.692 (range: 0.523 to 0.998). With sensor data, the best-performing group-level algorithm had an AUC of 0.952 (95% CI = 0.933-0.970). Its ability to classify lapses for out-of-sample individuals ranged from poor to excellent (AUCper person = 0.494-0.979; median AUC = 0.745). 11/30 participants had adequate data for individual-level algorithms to be constructed, with a median AUC of 0.983 (range: 0.549-1.000). Hybrid algorithms could be constructed for 20/30 participants, with a median AUC of 0.772 (range: 0.444 to 0.968). In conclusion, high-performing group-level lapse prediction algorithms without and with sensor data had variable performance when applied to out-of-sample individuals. Individual-level and hybrid algorithms could be constructed for a limited number of individuals but had improved performance, particularly when incorporating sensor data for participants with sufficient wear time. Feasibility constraints and the need to balance multiple success criteria in the JITAI development and implementation process are discussed.
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Affiliation(s)
- Olga Perski
- Faculty of Social Sciences, Tampere University, Finland
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, United States of America
- Department of Behavioural Science and Health, University College London, United Kingdom
| | - Dimitra Kale
- Department of Behavioural Science and Health, University College London, United Kingdom
| | - Corinna Leppin
- Department of Behavioural Science and Health, University College London, United Kingdom
| | - Tosan Okpako
- Department of Behavioural Science and Health, University College London, United Kingdom
| | - David Simons
- Centre for Emerging, Endemic and Exotic Diseases, Royal Veterinary College, United Kingdom
| | - Stephanie P. Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University & The Miriam Hospital/Weight Control and Diabetes Research Center, United States of America
| | - Eric Hekler
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, United States of America
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, United Kingdom
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Rungruanghiranya S, Tulatamakit S, Chittawatanarat K, Preedapornpakorn K, Wongphan T, Sutanthavibul N, Preechawong S, Petborom P. Efficacy and safety of cytisine versus nortriptyline for smoking cessation: A multicentre, randomized, double-blinded and placebo-controlled trial. Respirology 2024. [PMID: 39004954 DOI: 10.1111/resp.14787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/16/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND AND OBJECTIVE Cytisine serves as an affordable smoking cessation aid with acceptable safety profile. However, data comparing its efficacy and safety to standard therapies are limited. We aimed to examine efficacy and safety of cytisine compared to nortriptyline, which is the only approved smoking-cessation medication in Thailand. METHODS A 12-month, multicentre, randomized, double-blinded, placebo-controlled trial was conducted. Participants aged ≥20 years who smoked ≥10 cigarettes/day were randomly assigned to receive a 25-day cytisine or a 12-week nortriptyline treatment course. Brief interventions (BI) for smoking cessation were provided to all participants. The primary outcome was biochemically verified continuous abstinence rate (CAR) at 12 months. Additionally, self-reported abstinence, verified by exhaled carbon monoxide (CO) ≤ 10 ppm, was collected at 2 weeks, 1, 3, 6 and 12 months to assess both CAR and 7-day point prevalence abstinence rate (PAR). RESULTS A total of 1086 participants were recruited and randomized into cytisine (n = 540) and nortriptyline (n = 546) groups. The 12-month CAR was 12.22% for cytisine and 9.52% for nortriptyline. The relative difference was 0.03 (95% confidence interval [CI]; -0.01 to 0.06) and the relative risk was 1.28 (95% CI; 0.91-1.81). No differences were observed in secondary outcomes between both groups. The incidence of adverse effects from cytisine appeared to be lower than that of nortriptyline. CONCLUSION At 12 months, cytisine plus BI was as effective as nortriptyline plus BI for smoking cessation. The adverse events for both cytisine and nortriptyline were minimal and well-tolerated.
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Affiliation(s)
- Suthat Rungruanghiranya
- Department of Medicine, Faculty of Medicine, Srinakharinwirot University, NakhonNayok, Thailand
| | - Sirapat Tulatamakit
- Department of Medicine, Faculty of Medicine, Srinakharinwirot University, NakhonNayok, Thailand
| | | | - Kanokwan Preedapornpakorn
- HRH Mahachakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, NakhonNayok, Thailand
| | | | - Narueporn Sutanthavibul
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | - Pichaya Petborom
- Department of Medicine, Faculty of Medicine, Srinakharinwirot University, NakhonNayok, Thailand
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Jackson SE, Brown J, Tattan-Birch H, Shahab L. Impact of the disruption in supply of varenicline since 2021 on smoking cessation in England: A population study. Addiction 2024; 119:1203-1210. [PMID: 38688323 DOI: 10.1111/add.16485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND AND AIMS Varenicline is one of the most effective smoking cessation treatments. Its supply in England was disrupted in July 2021 due to nitrosamine impurities found by its supplier, Pfizer. This study measured the impact of this disruption on smoking cessation in England. DESIGN, SETTING AND PARTICIPANTS The study used repeated cross-sectional surveys conducted monthly, from June 2018 to December 2022. Set in England, it comprised a total of 3024 adults who reported smoking during the past year and had made at least one serious attempt to quit in the past 6 months. MEASUREMENTS Generalized additive models analyzed the association of the varenicline supply disruption with the trend in self-reported varenicline use in the most recent quit attempt. We used these results to estimate the population-level impact of the disruption on smoking cessation. FINDINGS Before July 2021, the proportion of past 6-month quit attempts using varenicline was stable at approximately 3.9% [risk ratio (RR)trend = 1.034, 95% confidence interval (CI) = 0.823-1.298]. The trend in varenicline use has changed sharply since the supply disruption (RRΔtrend = 0.297, 95% CI = 0.120-0.738), with prevalence falling by 69.3% per year since; from 4.1% in June 2021 to 0.8% in December 2022. Convergently, National Health Service general practitioner prescribing data reported that just 0.1% of prescriptions for smoking cessation treatments in December 2022 were for varenicline. Assuming that varenicline does not return to the market, we estimate that this could result in ~8400 fewer people stopping smoking for at least 6 months, ~4200 fewer long-term ex-smokers and ~1890 more avoidable deaths each year. CONCLUSIONS In England, the disruption in supply of varenicline since 2021 has coincided with a substantial fall in the use of varenicline in attempts to quit smoking.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
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Mundt MP, Stein JH, Fiore MC, Baker TB. Economic Evaluation of Enhanced vs Standard Varenicline Treatment for Tobacco Cessation. JAMA Netw Open 2024; 7:e248727. [PMID: 38683609 PMCID: PMC11059041 DOI: 10.1001/jamanetworkopen.2024.8727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/28/2024] [Indexed: 05/01/2024] Open
Abstract
Importance Smoking is the leading preventable cause of death and illness in the US. Identifying cost-effective smoking cessation treatment may increase the likelihood that health systems deliver such treatment to their patients who smoke. Objective To evaluate the cost-effectiveness of standard vs enhanced varenicline use (extended varenicline treatment or varenicline in combination with nicotine replacement therapy) among individuals trying to quit smoking. Design, Setting, and Participants This economic evaluation assesses the Quitting Using Intensive Treatments Study (QUITS), which randomized 1251 study participants who smoked into 4 conditions: (1) 12-week varenicline monotherapy (n = 315); (2) 24-week varenicline monotherapy (n = 311); (3) 12-week varenicline combination treatment with nicotine replacement therapy patch (n = 314); or (4) 24-week varenicline combination treatment with nicotine replacement therapy patch (n = 311). Study enrollment occurred in Madison and Milwaukee, Wisconsin, between November 11, 2017, and July 2, 2020. Statistical analysis took place from May to October 2023. Main Outcomes and Measures The primary outcome was 7-day point prevalence abstinence (biochemically confirmed with exhaled carbon monoxide level ≤5 ppm) at 52 weeks. The incremental cost-effectiveness ratio (ICER), or cost per additional person who quit smoking, was calculated using decision tree analysis based on abstinence and cost for each arm of the trial. Results Of the 1251 participants, mean (SD) age was 49.1 (11.9) years, 675 (54.0%) were women, and 881 (70.4%) completed the 52-week follow-up. Tobacco cessation at 52 weeks was 25.1% (79 of 315) for 12-week monotherapy, 24.4% (76 of 311) for 24-week monotherapy, 23.6% (74 of 314) for 12-week combination therapy, and 25.1% (78 of 311) for 24-week combination therapy, respectively. The total mean (SD) cost was $1175 ($365) for 12-week monotherapy, $1374 ($412) for 12-week combination therapy, $2022 ($813) for 24-week monotherapy, and $2118 ($1058) for 24-week combination therapy. The ICER for 12-week varenicline monotherapy was $4681 per individual who quit smoking and $4579 per quality-adjusted life-year (QALY) added. The ICER for 24-week varenicline combination therapy relative to 12-week monotherapy was $92 000 000 per additional individual who quit smoking and $90 000 000 (95% CI, $15 703 to dominated or more costly and less efficacious) per additional QALY. Conclusions and Relevance This economic evaluation of standard vs enhanced varenicline treatment for smoking cessation suggests that 12-week varenicline monotherapy was the most cost-effective treatment option at the commonly cited threshold of $100 000/QALY. This study provides patients, health care professionals, and other stakeholders with increased understanding of the health and economic impact of more intensive varenicline treatment options.
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Affiliation(s)
- Marlon P. Mundt
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison
| | - James H. Stein
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Michael C. Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Timothy B. Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
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Mundt MP, McCarthy DE, Baker TB, Zehner ME, Zwaga D, Fiore MC. Cost-Effectiveness of a Comprehensive Primary Care Smoking Treatment Program. Am J Prev Med 2024; 66:435-443. [PMID: 37844710 PMCID: PMC10922402 DOI: 10.1016/j.amepre.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Smoking is the leading preventable cause of death and disease in the U.S. This study evaluates the cost-effectiveness from a healthcare system perspective of a comprehensive primary care intervention to reduce smoking rates. METHODS This pragmatic trial implemented electronic health record prompts during primary care visits and employed certified tobacco cessation specialists to offer proactive outreach and smoking cessation treatment to patients who smoke. The data, analyzed in 2022, included 10,683 patients in the smoking registry from 2017 to 2020. Pre-post analyses compared intervention costs to treatment engagement, successful self-reported smoking cessation, and acute health care utilization (urgent care, emergency department visits, and inpatient hospitalization). Cost per quality-adjusted life year was determined by applying conversion factors obtained from the tobacco research literature to the cost per patient who quit smoking. RESULTS Tobacco cessation outreach, medication, and counseling costs increased from $2.64 to $6.44 per patient per month, for a total post-implementation intervention cost of $500,216. Smoking cessation rates increased from 1.3% pre-implementation to 8.7% post-implementation, for an incremental effectiveness of 7.4%. The incremental cost-effectiveness ratio was $628 (95% CI: $568, $695) per person who quit smoking, and $905 (95% CI: $822, $1,001) per quality-adjusted life year gained. Acute health care costs decreased by an average of $42 (95% CI: -$59, $145) per patient per month for patients in the smoking registry. CONCLUSIONS Implementation of a comprehensive and proactive smoking cessation outreach and treatment program for adult primary care patients who smoke meets typical cost-effectiveness thresholds for healthcare.
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Affiliation(s)
- Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Department of Medicine, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Department of Medicine, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Mark E Zehner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Department of Medicine, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Perski O, Li K, Pontikos N, Simons D, Goldstein SP, Naughton F, Brown J. Classification of Lapses in Smokers Attempting to Stop: A Supervised Machine Learning Approach Using Data From a Popular Smoking Cessation Smartphone App. Nicotine Tob Res 2023; 25:1330-1339. [PMID: 36971111 PMCID: PMC10256890 DOI: 10.1093/ntr/ntad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Smoking lapses after the quit date often lead to full relapse. To inform the development of real time, tailored lapse prevention support, we used observational data from a popular smoking cessation app to develop supervised machine learning algorithms to distinguish lapse from non-lapse reports. AIMS AND METHODS We used data from app users with ≥20 unprompted data entries, which included information about craving severity, mood, activity, social context, and lapse incidence. A series of group-level supervised machine learning algorithms (eg, Random Forest, XGBoost) were trained and tested. Their ability to classify lapses for out-of-sample (1) observations and (2) individuals were evaluated. Next, a series of individual-level and hybrid algorithms were trained and tested. RESULTS Participants (N = 791) provided 37 002 data entries (7.6% lapses). The best-performing group-level algorithm had an area under the receiver operating characteristic curve (AUC) of 0.969 (95% confidence interval [CI] = 0.961 to 0.978). Its ability to classify lapses for out-of-sample individuals ranged from poor to excellent (AUC = 0.482-1.000). Individual-level algorithms could be constructed for 39/791 participants with sufficient data, with a median AUC of 0.938 (range: 0.518-1.000). Hybrid algorithms could be constructed for 184/791 participants and had a median AUC of 0.825 (range: 0.375-1.000). CONCLUSIONS Using unprompted app data appeared feasible for constructing a high-performing group-level lapse classification algorithm but its performance was variable when applied to unseen individuals. Algorithms trained on each individual's dataset, in addition to hybrid algorithms trained on the group plus a proportion of each individual's data, had improved performance but could only be constructed for a minority of participants. IMPLICATIONS This study used routinely collected data from a popular smartphone app to train and test a series of supervised machine learning algorithms to distinguish lapse from non-lapse events. Although a high-performing group-level algorithm was developed, it had variable performance when applied to new, unseen individuals. Individual-level and hybrid algorithms had somewhat greater performance but could not be constructed for all participants because of the lack of variability in the outcome measure. Triangulation of results with those from a prompted study design is recommended prior to intervention development, with real-world lapse prediction likely requiring a balance between unprompted and prompted app data.
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Affiliation(s)
- Olga Perski
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Kezhi Li
- Institute of Health Informatics, University College London, London, UK
| | - Nikolas Pontikos
- UCL Institute of Ophthalmology, University College London, London, UK
| | - David Simons
- Centre for Emerging, Endemic and Exotic Diseases, Royal Veterinary College, London, UK
| | - Stephanie P Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Felix Naughton
- Behavioural and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
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Taylor AH, Thompson TP, Streeter A, Chynoweth J, Snowsill T, Ingram W, Ussher M, Aveyard P, Murray RL, Harris T, Green C, Horrell J, Callaghan L, Greaves CJ, Price L, Cartwright L, Wilks J, Campbell S, Preece D, Creanor S. Motivational support intervention to reduce smoking and increase physical activity in smokers not ready to quit: the TARS RCT. Health Technol Assess 2023; 27:1-277. [PMID: 37022933 PMCID: PMC10150295 DOI: 10.3310/kltg1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Background Physical activity can support smoking cessation for smokers wanting to quit, but there have been no studies on supporting smokers wanting only to reduce. More broadly, the effect of motivational support for such smokers is unclear. Objectives The objectives were to determine if motivational support to increase physical activity and reduce smoking for smokers not wanting to immediately quit helps reduce smoking and increase abstinence and physical activity, and to determine if this intervention is cost-effective. Design This was a multicentred, two-arm, parallel-group, randomised (1 : 1) controlled superiority trial with accompanying trial-based and model-based economic evaluations, and a process evaluation. Setting and participants Participants from health and other community settings in four English cities received either the intervention (n = 457) or usual support (n = 458). Intervention The intervention consisted of up to eight face-to-face or telephone behavioural support sessions to reduce smoking and increase physical activity. Main outcome measures The main outcome measures were carbon monoxide-verified 6- and 12-month floating prolonged abstinence (primary outcome), self-reported number of cigarettes smoked per day, number of quit attempts and carbon monoxide-verified abstinence at 3 and 9 months. Furthermore, self-reported (3 and 9 months) and accelerometer-recorded (3 months) physical activity data were gathered. Process items, intervention costs and cost-effectiveness were also assessed. Results The average age of the sample was 49.8 years, and participants were predominantly from areas with socioeconomic deprivation and were moderately heavy smokers. The intervention was delivered with good fidelity. Few participants achieved carbon monoxide-verified 6-month prolonged abstinence [nine (2.0%) in the intervention group and four (0.9%) in the control group; adjusted odds ratio 2.30 (95% confidence interval 0.70 to 7.56)] or 12-month prolonged abstinence [six (1.3%) in the intervention group and one (0.2%) in the control group; adjusted odds ratio 6.33 (95% confidence interval 0.76 to 53.10)]. At 3 months, the intervention participants smoked fewer cigarettes than the control participants (21.1 vs. 26.8 per day). Intervention participants were more likely to reduce cigarettes by ≥ 50% by 3 months [18.9% vs. 10.5%; adjusted odds ratio 1.98 (95% confidence interval 1.35 to 2.90] and 9 months [14.4% vs. 10.0%; adjusted odds ratio 1.52 (95% confidence interval 1.01 to 2.29)], and reported more moderate-to-vigorous physical activity at 3 months [adjusted weekly mean difference of 81.61 minutes (95% confidence interval 28.75 to 134.47 minutes)], but not at 9 months. Increased physical activity did not mediate intervention effects on smoking. The intervention positively influenced most smoking and physical activity beliefs, with some intervention effects mediating changes in smoking and physical activity outcomes. The average intervention cost was estimated to be £239.18 per person, with an overall additional cost of £173.50 (95% confidence interval -£353.82 to £513.77) when considering intervention and health-care costs. The 1.1% absolute between-group difference in carbon monoxide-verified 6-month prolonged abstinence provided a small gain in lifetime quality-adjusted life-years (0.006), and a minimal saving in lifetime health-care costs (net saving £236). Conclusions There was no evidence that behavioural support for smoking reduction and increased physical activity led to meaningful increases in prolonged abstinence among smokers with no immediate plans to quit smoking. The intervention is not cost-effective. Limitations Prolonged abstinence rates were much lower than expected, meaning that the trial was underpowered to provide confidence that the intervention doubled prolonged abstinence. Future work Further research should explore the effects of the present intervention to support smokers who want to reduce prior to quitting, and/or extend the support available for prolonged reduction and abstinence. Trial registration This trial is registered as ISRCTN47776579. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adrian H Taylor
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Tom P Thompson
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Adam Streeter
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Jade Chynoweth
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Tristan Snowsill
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Wendy Ingram
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tess Harris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Colin Green
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jane Horrell
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Lynne Callaghan
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Lisa Price
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Lucy Cartwright
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Jonny Wilks
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Sarah Campbell
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Dan Preece
- Public Health, Plymouth City Council, Plymouth, UK
| | - Siobhan Creanor
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
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9
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Shepard DS, Slade EP, Nighbor TD, DeSarno MJ, Roemhildt ML, Williams RK, Higgins ST. Economic analysis of financial incentives for smoking cessation during pregnancy and postpartum. Prev Med 2022; 165:107079. [PMID: 35533885 PMCID: PMC11226006 DOI: 10.1016/j.ypmed.2022.107079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
Higgins and colleagues' recently-completed randomized controlled trial and pooled data with 4 related trials of smoking cessation in pregnant women in Vermont (USA) showed that abstinence-contingent financial incentives (FI) increased abstinence over control conditions from early pregnancy through 24-weeks postpartum. Control conditions were best practices (BP) alone in the recent trial and payments provided independent of smoking status (noncontingently) in the others. This paper reports economic analyses of abstinence-contingent FI. Merging trial results with maternal and infant healthcare costs from all Vermont Medicaid deliveries in 2019, we computed incremental cost-effectiveness ratios (ICERs) for quality-adjusted life years (QALYs) and compared them to established thresholds. The healthcare sector cost (±standard error) of adding FI to BP averaged $634.76 ± $531.61 per participant. Based on this trial, the increased probability per BP + FI participant of smoking abstinence at 24-weeks postpartum was 3.17%, the cost per additional abstinent woman was $20,043, the incremental health gain was 0.0270 ± 0.0412 QALYs, the ICER was $23,511/QALY gained, and the probabilities that BP + FI was very cost-effective (ICER≤$65,910) and cost-effective (ICER≤$100,000) were 67.9% and 71.0%, respectively. Based on the pooled trials, the corresponding values were even more favorable-8.89%, $7138, 0.0758 ± 0.0178 QALYs, $8371/QALY, 98.6% and 99.3%, respectively. Each dollar invested in abstinence-contingent FI over control smoking-cessation programs yielded $4.20 in economic benefits in the recent trial and $11.90 in the pooled trials (very favorable benefit-cost ratios). Medicaid and commercial insurers may wish to consider covering financial incentives for smoking abstinence as a cost-effective service for pregnant beneficiaries who smoke. Trial Registration: ClinicalTrials.gov identifier: NCT02210832.
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Affiliation(s)
- Donald S Shepard
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Heller School for Social Poilcy and Management, MS 035, Brandeis University, Waltham, MA 02454-9110 USA.
| | - Eric P Slade
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Johns Hopkins University School of Nursing, USA
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
| | - Michael J DeSarno
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Department of Medical Biostatistics, University of Vermont, USA
| | | | | | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
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10
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Phillips LC, Nguyen H, Genge TL, Maddigan WJ. Effectiveness and cost-effectiveness of an intensive and abbreviated individualized smoking cessation program delivered by pharmacists: A pragmatic, mixed-method, randomized trial. Can Pharm J (Ott) 2022; 155:334-344. [PMID: 36386606 PMCID: PMC9647399 DOI: 10.1177/17151635221128263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/27/2022] [Accepted: 07/12/2022] [Indexed: 06/21/2024]
Abstract
BACKGROUND Tobacco use is the leading preventable cause of morbidity and mortality in Canada. Smoking cessation programs (SCPs) that are effective, cost-effective and widely available are needed to help smokers quit. Pharmacists are uniquely positioned to provide such services. This study compares the abstinence rates between 2 pharmacist-led SCPs and the cost-effectiveness between these and a comparator group. The study was conducted in St. John's, Newfoundland and Labrador. METHODS This pragmatic, mixed-method trial randomized smokers to either an existing intensive SCP or a new abbreviated SCP designed for community pharmacies. The primary outcome was 6-month abstinence rates. Cost-effectiveness was determined using abstinence rates for the SCPs and a comparator group. Incremental costs per additional quit were calculated for the trial duration, and incremental costs per life-year gained were estimated over a lifetime. RESULTS Quit rates for the SCPs were 36% (intensive) and 22% (abbreviated) (p = 0.199). Incremental costs per life-year gained for the SCPs were $1576 (intensive) and $1836 (abbreviated). The incremental costs per additional quit, relative to the comparator group, for the SCPs were $1217 (intensive) and $1420 (abbreviated). DISCUSSION Both SCPs helped smokers quit, and quit rates exceeded those reported for a comparator group that included a general population of adult smokers (~7%). The incremental costs per additional quit for both SCPs compare favourably to those reported for other initiatives such as quit lines and hospital-based interventions. CONCLUSION Pharmacist-led smoking cessation programs are effective and highly cost-effective. Widespread implementation, facilitated by remuneration, has potential to lower smoking prevalence and associated costs and harms.
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11
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Russell LB, Volpp KG, Kwong PL, Cosgriff BS, Harhay MO, Zhu J, Halpern SD. Cost-Effectiveness of Four Financial Incentive Programs for Smoking Cessation. Ann Am Thorac Soc 2021; 18:1997-2006. [PMID: 33979562 PMCID: PMC8641815 DOI: 10.1513/annalsats.202012-1473oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/12/2021] [Indexed: 11/20/2022] Open
Abstract
Rationale: A trial of four financial incentive programs, conducted at CVS Caremark, a large employer, documented their effectiveness in promoting sustained abstinence from smoking, but their cost-effectiveness is unknown, and the significant up-front cost of the incentives is a deterrent to their adoption. Objectives: To determine the cost-effectiveness of these incentives from the healthcare sector and employer perspectives. Methods: This study examines a decision model built with trial data, supplemented by data from the literature. Life-expectancy gains for quitters were projected on the basis of U.S. life tables. The two individual-oriented programs paid $800 for smoking cessation at 6 months; one required participants to deposit $150 at baseline. Payments in the two group-oriented programs varied with the group's success; again, one required participants to deposit $150. Results: Life-years, quality-adjusted life-years (QALYs), costs (2012 dollars), and cost-effectiveness ratios are described. From the healthcare sector perspective, costs ranged from $3,200 per life-year ($2,500 per QALY) for the competitive deposit program, compared with usual care, to $6,500 per life-year ($5,100 per QALY) for the individual reward program. From the employer perspective, costs ranged from $256,600 per life-year gained for the individual deposit program to $1,711,100 per life-year gained for the individual reward program; the cost per QALY ranged from $65,300 for the competitive deposit program to $128,800 for the individual reward program. Cost-effectiveness from the employer perspective improved with longer decision horizons. Including future medical costs reduced cost-effectiveness from both perspectives. Conclusions: Four financial incentive programs that paid smokers to quit are very cost-effective from the healthcare sector perspective. They are more expensive from the employer perspective but may be cost-effective for employers with longer decision horizons.
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Affiliation(s)
- Louise B. Russell
- Department of Medical Ethics and Health Policy
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy
- Department of Medicine, and
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Pui L. Kwong
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics
| | | | - Michael O. Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics
| | - Jingsan Zhu
- Department of Medical Ethics and Health Policy
- Center for Health Incentives and Behavioral Economics
| | - Scott D. Halpern
- Department of Medical Ethics and Health Policy
- Department of Medicine, and
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
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12
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Brown HS, Patel U, Seidel S, LeMaistre A, Wilson K. Local Marketing of a National Texting-Based Smoking Cessation Program: Is It Cost Effective? Front Public Health 2020; 8:116. [PMID: 32457862 PMCID: PMC7221146 DOI: 10.3389/fpubh.2020.00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
Tailored texting interventions for smoking cessation are increasingly popular given the ubiquitousness of smart phones. Because high development costs and limited expertise may pose substantial barriers to designing and implementing these programs at the local level, utilization of existing programs at the national level is a promising strategy. In 2011, Austin Public Health focused on promoting smoking cessation among Austin/Travis County residents. Their strategy involved marketing and linking their citizens to a federally-funded, evidence-based smoking cessation program via texting. The target audience was low income, 18–24 year olds. Their marketing strategies included radio ads, digital ads, social media ads, and direct outreach at events in Austin, Texas. During the period between April 2016 and July 2017, 1,022 people signed up for the program. The quit rate was comparable to other texting programs which were tailored at the local level, and the program was cost-effective, costing $12,704.56 per life-year added, averting $99.38 per person in medical costs, discounted at 3%.
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Affiliation(s)
- Henry Shelton Brown
- UTHealth, University of Texas School of Public Health, Austin, TX, United States
| | - Ujas Patel
- UTHealth, University of Texas School of Public Health, Austin, TX, United States
| | | | | | - Kim Wilson
- UTHealth, University of Texas School of Public Health, Austin, TX, United States
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13
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Song F, Elwell-Sutton T, Naughton F, Gentry S. Future smoking prevalence by socioeconomic status in England: a computational modelling study. Tob Control 2020; 30:tobaccocontrol-2019-055490. [PMID: 32447314 PMCID: PMC8237189 DOI: 10.1136/tobaccocontrol-2019-055490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/02/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The difference in smoking across socioeconomic groups is a major cause of health inequality. This study projected future smoking prevalence by socioeconomic status, and revealed what is needed to achieve the tobacco-free ambition (TFA) by 2030 in England. METHODS Using data from multiple sources, the adult (≥18 years) population in England was separated into subgroups by smoking and highest educational qualification (HEQ). A discrete time state-transition model was used to project future smoking prevalence by HEQ deterministically and stochastically. RESULTS In a status quo scenario, smoking prevalence in England is projected to be 10.8% (95% uncertainty interval: 9.1% to 12.9%) by 2022, 7.8% (5.5% to 11.0%) by 2030 and 6.0% (3.7% to 9.6%) by 2040. The absolute difference in smoking rate between low and high HEQ is reduced from 12.2% in 2016 to 7.9% by 2030, but the relative inequality (low/high HEQ ratio) is increased from 2.48 in 2016 to 3.06 by 2030. When applying 2016 initiation/relapse rates, achievement of the TFA target requires no changes to future cessation rates among adults with high qualifications, but increased rates of 37% and 149%, respectively, in adults with intermediate and low qualifications. CONCLUSIONS If the current trends continue, smoking prevalence in England is projected to decline in the future, but with substantial differences across socioeconomic groups. Absolute inequalities in smoking are likely to decline and relative inequalities in smoking are likely to increase in future. The achievement of England's TFA will require the reduction of both absolute and relative inequalities in smoking by socioeconomic status.
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Affiliation(s)
- Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich, UK
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14
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van den Brand FA, Nagelhout GE, Winkens B, Chavannes NH, van Schayck OCP, Evers SMAA. Cost-effectiveness and cost-utility analysis of a work-place smoking cessation intervention with and without financial incentives. Addiction 2020; 115:534-545. [PMID: 31849138 PMCID: PMC7027826 DOI: 10.1111/add.14861] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/07/2019] [Accepted: 10/14/2019] [Indexed: 11/29/2022]
Abstract
AIMS To perform an economic evaluation of a work-place smoking cessation group training programme with incentives compared with a training programme without incentives. DESIGN A trial-based cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a societal perspective and an employer's perspective. SETTING Sixty-one companies in the Netherlands. PARTICIPANTS A total of 604 tobacco-smoking employees. INTERVENTION AND COMPARATOR A 7-week work-place smoking cessation group training programme. The intervention group earned gift vouchers of €350 for 12 months' continuous abstinence. The comparator group received no incentives. MEASUREMENTS Online questionnaires were administered to assess quality of life (EQ-5D-5 L) and resource use during the 14-month follow-up period (2-month training period plus 12-month abstinence period). For the CEA the primary outcome measure was carbon monoxide (CO)-validated continuous abstinence; for the CUA the primary outcome was quality-adjusted life years (QALY). Bootstrapping and sensitivity analyses were performed to account for uncertainty. Incremental cost-effectiveness ratio (ICER) tables were used to determine cost-effectiveness from a life-time perspective. FINDINGS Of the participants in the intervention group, 41.1% had quit smoking compared with 26.4% in the control group. From a societal perspective with a 14-month follow-up period, the ICER per quitter for an intervention with financial incentives compared with no incentives was €11 546. From an employer's perspective, the ICER was €5686. There was no significant difference in QALYs between the intervention and control group within the 14-month follow-up period. The intervention was dominated by the comparator in the primary analysis at a threshold of €20 000 per QALY. In the sensitivity analysis, these results were uncertain. A life-time perspective showed an ICER of €1249 (95% confidence interval = €850-2387) per QALY. CONCLUSIONS Financial incentives may be cost-effective in increasing quitting smoking, particularly from a life-time perspective.
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Affiliation(s)
| | - Gera E. Nagelhout
- Department of Family MedicineMaastricht University (CAPHRI)Maastrichtthe Netherlands,Department of Health PromotionMaastricht University (CAPHRI)Maastrichtthe Netherlands,IVO Research InstituteThe Haguethe Netherlands
| | - Bjorn Winkens
- Department of Methodology and StatisticsMaastricht University (CAPHRI)Maastrichtthe Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenthe Netherlands
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15
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Jackson SE, Perski O, Crane D, Michie S, West R, Brown J. Effectiveness of an offer of the Smoke Free smartphone application for smoking cessation: protocol for a randomized controlled trial. Addiction 2019; 114:2078-2086. [PMID: 31083767 DOI: 10.1111/add.14652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/10/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Smartphone applications (apps) hold promise for delivering tobacco smoking cessation support to large numbers of people at low unit cost. Smoke Free is an evidence-informed, widely used app that is highly rated by users. This study aims to assess its effectiveness compared with no support. DESIGN Two-arm individually randomized controlled effectiveness trial. SETTING Online trial with no restrictions on location. PARTICIPANTS English-speaking smokers aged ≥ 18 years willing to make a quit attempt within 4 weeks from initial contact (n = 4990). MEASUREMENTS The primary outcome measure is self-reported 26-week continuous smoking abstinence. Secondary outcome measures include quit attempts in the first 4 weeks post-randomization, 12-week continuous smoking abstinence and 26-week continuous smoking abstinence among those who made a quit attempt. COMMENTS If it is effective, the Smoke Free smartphone app is an affordable and widely implementable intervention to help smokers to quit.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, UK
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, UK
| | - David Crane
- Department of Behavioural Science and Health, University College London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, UK
- Department of Clinical, Educational and Health Psychology, University College London, UK
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16
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Tutka P, Vinnikov D, Courtney RJ, Benowitz NL. Cytisine for nicotine addiction treatment: a review of pharmacology, therapeutics and an update of clinical trial evidence for smoking cessation. Addiction 2019; 114:1951-1969. [PMID: 31240783 DOI: 10.1111/add.14721] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/08/2019] [Accepted: 06/18/2019] [Indexed: 01/30/2023]
Abstract
AIMS To review cytisine's history of use, pre-clinical evidence, clinical pharmacokinetics, efficacy, adverse reactions (ARs) and safety for smoking cessation. METHODS A synoptic review of the use of cytisine as a smoking cessation medication, mechanism of action, pharmacokinetics and safety. Relevant literature on data included in these sections were identified through a search of 11 databases with additional literature obtained from reports and monographs. Three databases (PubMed, EMBASE and www.elibrary.ru) were systematically searched for studies published from 2012 to August 2018 in any language to provide an updated meta-analysis of cytisine's efficacy and ARs for smoking cessation compared with placebo. We pooled the relative risks (RR) of abstinence in the efficacy analysis and RR of ARs, either reported by the authors or calculated from the reports. RESULTS Cytisine has been in use since 1964 and is currently marketed in 18 countries. Systemic bioavailability from oral ingestion is high and clearance is primarily renal, with minimal or no metabolism. Brain uptake in animal models is moderate. The plasma half-life averages 4.8 hours. Eight studies were included for meta-analysis of efficacy. With heterogeneous results, the overall RR versus placebo of successful continuous abstinence at the longest follow-up was 1.74 [95% confidence interval (CI) = 1.38-2.19]. Nausea, vomiting, dyspepsia, upper abdominal pain and dry mouth that were mild or moderate were the most common ARs, with RR versus placebo 1.10 (95% CI = 0.95-1.28). The cost of cytisine in eastern and central Europe is several-fold less than that of other smoking cessation medications. CONCLUSIONS Cytisine is a low-cost medication found to increase the likelihood of smoking cessation. The most frequently reported ARs of cytisine involve gastrointestinal symptoms that are mostly reported as either mild or moderate in severity.
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Affiliation(s)
- Piotr Tutka
- Department of Experimental and Clinical Pharmacology, University of Rzeszów, Rzeszów, Poland.,Laboratory for Innovative Research in Pharmacology, University of Rzeszów, Rzeszów, Poland.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Denis Vinnikov
- School of Public Health, Al-Farabi Kazakh National University, Almaty, Kazakhstan.,Biological Institute, National Research Tomsk State University, Tomsk, Russia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
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17
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Cheung YTD, Lam TH, Li WHC, Wang MP, Chan SSC. Feasibility, Efficacy, and Cost Analysis of Promoting Smoking Cessation at Outdoor Smoking "Hotspots": A Pre-Post Study. Nicotine Tob Res 2019; 20:1519-1524. [PMID: 28655173 DOI: 10.1093/ntr/ntx147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/21/2017] [Indexed: 11/13/2022]
Abstract
Introduction To motivate smokers to quit, there is a need for enhanced smoking cessation (SC) recruitment and for innovative and proactive approaches to SC. This study evaluated the feasibility, efficacy, and cost of promoting SC in public outdoor areas where smokers gather to smoke (smoking hotspots). Methods We selected 14 smoking hotspots in Hong Kong for SC promotion in 2015. University students were trained as SC ambassadors to deliver brief SC intervention, and to recruit smokers for telephone follow-up. The proportion of smokers accepting the intervention components was recorded. Self-reported abstinence in the past 7 days and knowledge of smoking and health were assessed at the 6-month follow-up. The average costs of each smoker receiving our intervention and quitting were also compared. Results Of 3,080 smokers approached, 1,278 (41.5%) accepted the souvenir and 920 (29.9%) received brief advice. Of the 210 (6.8%) who consented to the follow-up, 24.5% were aged 15-29 and 46.4% were aged 30-49. Of the 151 smokers successfully contacted within 1 month after recruitment, 16 (10.6%; 1.3% of the 1,278 who received any form of intervention) reported abstinence, and their overall knowledge improved. The average costs for a smoker to receive brief advice, consent to follow up by telephone, attempt to quit, and quit successfully at the 6-month follow-up were US$30, US$132, US$601, and US$1,626, respectively. Conclusions Promoting SC at smoking hotspots could be a feasible way to achieve satisfactory quitting outcomes at low cost and is useful in the absence of the strengthening of tobacco policies. Implications Our study indicates that outdoor smoking hotspots are feasible platforms for promoting SC and recruiting smokers for cessation services; satisfactory outcomes can be achieved at a reasonable cost. Our promotion was particularly useful for recruiting young smokers and those who want to quit. It is feasible and efficacious to raise smokers' awareness of SC when other tobacco control policies not feasible. Indoor smoking bans or other substantial tobacco control policies could enhance the efficiency with which SC is promoted.
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Affiliation(s)
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Pokfulam, Hong Kong
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18
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Thomas D, Farrell M, McRobbie H, Tutka P, Petrie D, West R, Siahpush M, Gartner C, Walker N, Mendelsohn CP, Hall W, Paul C, Zwar N, Ferguson SG, Boland VC, Richmond R, Doran CM, Shakeshaft A, Mattick RP, Courtney RJ. The effectiveness, safety and cost-effectiveness of cytisine versus varenicline for smoking cessation in an Australian population: a study protocol for a randomized controlled non-inferiority trial. Addiction 2019; 114:923-933. [PMID: 30589984 DOI: 10.1111/add.14541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/28/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Smoking cessation medications are effective, but often underutilized because of costs and side effects. Cytisine is a plant-based smoking cessation medication with more than 50 years of use in central and eastern Europe. While cytisine has been found to be well-tolerated and more effective than nicotine replacement therapy, direct comparisons with varenicline have not been conducted. This study evaluates the effectiveness, safety and cost-effectiveness of cytisine compared with varenicline. DESIGN Two-arm, parallel group, randomized, non-inferiority trial, with allocation concealment and blinded outcome assessment. SETTING Australian population-based study. PARTICIPANTS Adult daily smokers (n = 1266) interested in quitting will be recruited through advertisements and Quitline telephone-based cessation support services. INTERVENTION AND COMPARATOR Eligible participants will be randomized (1 : 1 ratio) to receive either cytisine capsules (25-day supply) or varenicline tablets (12-week supply), prescribed in accordance with the manufacturer's recommended dosing regimen. The medication will be mailed to each participant's nominated residential address. All participants will also be offered standard Quitline behavioural support (up to six 10-12-minute sessions). MEASUREMENTS Assessments will be undertaken by telephone at baseline, 4 and 7 months post-randomization. Participants will also be contacted twice (2 and 4 weeks post-randomization) to ascertain adverse events, treatment adherence and smoking status. The primary outcome will be self-reported 6-month continuous abstinence from smoking, verified by carbon monoxide at 7-month follow-up. We will also evaluate the relative safety and cost-effectiveness of cytisine compared with varenicline. Secondary outcomes will include self-reported continuous and 7-day point prevalence abstinence and cigarette consumption at each follow-up interview. COMMENTS If cytisine is as effective as varenicline, its lower cost and natural plant-based composition may make it an acceptable and affordable smoking cessation medication that could save millions of lives world-wide.
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Affiliation(s)
- Dennis Thomas
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia.,Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Piotr Tutka
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia.,Department of Experimental and Clinical Pharmacology, Laboratory for Innovative Research in Pharmacology, University of Rzeszów, Rzeszów, Poland
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Mohammad Siahpush
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Coral Gartner
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Colin P Mendelsohn
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Wayne Hall
- Faculty of Health and Behavioural Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia.,National Addiction Centre, Kings College London, UK
| | - Christine Paul
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.,Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | | | - Veronica C Boland
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Christopher M Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, Brisbane, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Sydney, Australia
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Song F, Elwell-Sutton T, Naughton F. Impact of the NHS Stop Smoking Services on smoking prevalence in England: a simulation modelling evaluation. Tob Control 2019; 29:200-206. [PMID: 30952692 PMCID: PMC7042976 DOI: 10.1136/tobaccocontrol-2018-054879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/31/2019] [Accepted: 02/09/2019] [Indexed: 11/05/2022]
Abstract
Background The English National Health Service NHS Stop Smoking Services (SSS), established in 2001, were the first such services in the world. An appropriate evaluation of the SSS has national and international significance. This modelling study sought to evaluate the impact of the SSS on changes in smoking prevalence in England. Methods A discrete time state-transition model was developed to simulate changes in smoking status among the adult population in England during 2001–2016. Input parameters were based on data from national statistics, population representative surveys and published literature. The main outcome was the percentage point reduction in smoking prevalence attributable to the SSS. Results Smoking prevalence was reduced by 10.8 % in absolute terms during 2001–2016 in England, and 15.3 % of the reduction could be attributable to the SSS. The percentage point reduction in smoking prevalence each year was on average 0.72%, and 0.11 % could be attributable to the SSS. The proportion of SSS supported quit attempts increased from 5.5 % in 2001, to as high as 18.9 % in 2011, and then reduced to 8.2 % in 2016. Quit attempts with SSS support had a higher success rate than those without SSS support (15.1% vs 11.3%). Smoking prevalence in England continued to decline after the SSS was much reduced from 2013 onwards. Conclusions Approximately 15% of the percentage point reduction in smoking prevalence during 2001–2016 in England may be attributable to the NHS SSS, although uncertainty remains regarding the actual impact of the formal smoking cessation services.
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Affiliation(s)
- Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
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20
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Castaldelli-Maia JM, Martins SS, Walker N. The effectiveness of Cytisine versus Nicotine Replacement Treatment for smoking cessation in the Russian Federation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 58:121-125. [DOI: 10.1016/j.drugpo.2018.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/24/2018] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
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21
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Kuipers MAG, Beard E, West R, Brown J. Associations between tobacco control mass media campaign expenditure and smoking prevalence and quitting in England: a time series analysis. Tob Control 2018; 27:455-462. [PMID: 28667091 PMCID: PMC6047146 DOI: 10.1136/tobaccocontrol-2017-053662] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/06/2017] [Accepted: 05/30/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND It has been established that mass media campaigns can increase smoking cessation rates, but there is little direct evidence estimating associations between government expenditure on tobacco control mass media campaigns and smoking cessation. This study assessed the association over 8 years between mass media expenditure in England and quit attempts, smoking cessation and smoking prevalence. METHODS Autoregressive integrated moving average modelling with exogenous variables (ARIMAX) was applied to monthly estimates from the Smoking Toolkit Study between June 2008 and February 2016. We assessed the association between the trends in mass media expenditure and (1) quit attempts in the last two months, (2) quit success among those who attempted to quit and (3) smoking prevalence. Analyses were adjusted for trends in weekly spending on tobacco by smokers, tobacco control policies and the use of established aids to cessation. RESULTS Monthly spending on mass media campaigns ranged from nothing to £2.4 million, with a mean of £465 054. An increase in mass media expenditure of 10% of the monthly average was associated with a 0.51% increase (of the average) in success rates of quit attempts (95% CI 0.10% to 0.91%, p=0.014). No clear association was detected between changes in mass media expenditure and changes in quit attempt prevalence (β=-0.03, 95% CI -2.05% to 2.00%, p=0.979) or smoking prevalence (β=-0.03, 95% CI -0.09% to 0.03%, p=0.299). CONCLUSION Between 2008 and 2016, higher monthly expenditure on tobacco control mass media campaigns in England was associated with higher quit success rates.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Epidemiology and Public Health, University College London, London, UK
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Emma Beard
- Department of Epidemiology and Public Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Robert West
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jamie Brown
- Department of Epidemiology and Public Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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22
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Levy DE, Klinger EV, Linder JA, Fleegler EW, Rigotti NA, Park ER, Haas JS. Cost-Effectiveness of a Health System-Based Smoking Cessation Program. Nicotine Tob Res 2018; 19:1508-1515. [PMID: 27639095 DOI: 10.1093/ntr/ntw243] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 09/16/2016] [Indexed: 11/12/2022]
Abstract
Introduction Project CLIQ (Community Link to Quit) was a proactive population-outreach strategy using an electronic health records-based smoker registry and interactive voice recognition technology to connect low- to moderate-income smokers with cessation counseling, medications, and social services. A randomized trial demonstrated that the program increased cessation. We evaluated the cost-effectiveness of CLIQ from a provider organization's perspective if implemented outside the trial framework. Methods We calculated the cost, cost per smoker, incremental cost per additional quit, and, secondarily, incremental cost per additional life year saved of the CLIQ system compared to usual care using data from a 2011-2013 randomized trial assessing the effectiveness of the CLIQ system. Sensitivity analyses considered economies of scale and initial versus ongoing costs. Results Over a 20-month period (the duration of the trial) the program cost US $283 027 (95% confidence interval [CI] $209 824-$389 072) more than usual care in a population of 8544 registry-identified smokers, 707 of whom participated in the program. The cost per smoker was $33 (95% CI 28-40), incremental cost per additional quit was $4137 (95% CI $2671-$8460), and incremental cost per additional life year saved was $7301 (95% CI $4545-$15 400). One-time costs constituted 28% of costs over 20 months. Ongoing costs were dominated by personnel costs (71% of ongoing costs). Sensitivity analyses showed sharp gains in cost-effectiveness as the number of identified smokers increased because of the large initial costs. Conclusions The CLIQ system has favorable cost-effectiveness compared to other smoking cessation interventions. Cost-effectiveness will be greatest for health systems with high numbers of smokers and with the high smoker participation rates. Implications Health information systems capable of establishing registries of patients who are smokers are becoming more prevalent. This economic analysis illustrates the cost implications for health care systems adopting a proactive tobacco treatment outreach strategy for low- and middle-income smokers. We find that under many circumstances, the CLIQ system has a favorable cost-per-quit compared to other population-based tobacco treatment strategies. The strategy could be widely disseminable if health systems leverage economies of scale.
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Affiliation(s)
- Douglas E Levy
- Mongan Institute Health Policy Center and Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Elissa V Klinger
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jeffrey A Linder
- Department of Medicine, Harvard Medical School, Boston, MA.,Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.,Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Nancy A Rigotti
- Mongan Institute Health Policy Center and Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Elyse R Park
- Mongan Institute Health Policy Center and Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Jennifer S Haas
- Department of Medicine, Harvard Medical School, Boston, MA.,Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
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23
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Healey A, Roberts S, Sevdalis N, Goulding L, Wilson S, Shaw K, Jolley C, Robson D. A Cost-Effectiveness Analysis of Stop Smoking Interventions in Substance-Use Disorder Populations. Nicotine Tob Res 2018; 21:623-630. [DOI: 10.1093/ntr/nty087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/30/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Andrew Healey
- King’s Improvement Science, King’s College London, UK
| | - Sarah Roberts
- King’s Improvement Science, King’s College London, UK
| | - Nick Sevdalis
- King’s Improvement Science, King’s College London, UK
| | - Lucy Goulding
- King’s Improvement Science, King’s College London, UK
| | - Sophie Wilson
- King’s Improvement Science, King’s College London, UK
| | - Kate Shaw
- King’s Improvement Science, King’s College London, UK
| | - Caroline Jolley
- Centre of Human & Aerospace Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, UK
- Department of Respiratory Medicine, King’s College Hospital NHS Foundation Trust, UK
| | - Deborah Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
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24
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van Rossem C, Spigt M, Viechtbauer W, Lucas AEM, van Schayck OCP, Kotz D. Effectiveness of intensive practice nurse counselling versus brief general practitioner advice, both combined with varenicline, for smoking cessation: a randomized pragmatic trial in primary care. Addiction 2017; 112:2237-2247. [PMID: 28667826 DOI: 10.1111/add.13927] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/02/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
AIMS To study the effectiveness of intensive counselling by a practice nurse (PN) versus brief advice by a general practitioner (GP), each combined with pharmacotherapy, for 6 months' tobacco abstinence (primary outcome). Secondary outcomes included 12-month abstinence, medication adherence and incremental costs per life-year gained. DESIGN A multi-site (n = 10), two-group, parallel, pragmatic randomized controlled trial. SETTING A network of primary health-care centres in the Netherlands. PARTICIPANTS A total of 295 adult daily smokers (mean age = 48 years; mean cigarettes/day = 19). INTERVENTION AND COMPARATOR Patients were randomized to receive individual counselling by a practice nurse (PN) (n = 149) or brief advice by a general practitioner (GP) (146). All patients received 12 weeks of open-label varenicline. MEASUREMENTS The primary outcome was prolonged biochemically validated abstinence from weeks 9 to 26 after treatment initiation. Secondary outcomes included abstinence from weeks 9 to 52, good dosing adherence (> 80% days taken) and incremental costs per life-year gained. FINDINGS Abstinence rates in the PN versus GP groups were 32.2% (n = 48) versus 39.0% [n = 57; odds ratio (OR) = 0.71; 95% confidence interval (CI) = 0.44-1.16] from weeks 9 to 26 and 25.5% (n = 38) versus 28.8% (n = 42; OR = 0.84, 95% CI = 0.50-1.43) from weeks 9 to 52, respectively. Values of the Bayes factor indicated that the PN and GP were equally effective. Good dosing adherence was significantly lower in the PN (45.5%, n = 56/123) than in the GP group (62.0%, n = 75/121; OR = 0.45, 95% CI = 0.26-0.77), and the incremental costs per life-year gained were -€416.10. CONCLUSIONS Among people seeking help to stop smoking from their general practice, one-off brief advice from a general practitioner appears to be as effective as several sessions of behavioural support from a practice nurse when smoking cessation medication is provided.
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Affiliation(s)
- Carolien van Rossem
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Mark Spigt
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.,General Practice Research Unit, Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Wolfgang Viechtbauer
- MHeNS School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Annelies E M Lucas
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.,Eindhoven Corporation of Primary Health Care Centres (SGE), Eindhoven, the Netherlands
| | - Onno C P van Schayck
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Daniel Kotz
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.,Institute of General Practice, Addiction Research and Clinical Epidemiology unit, Medical Faculty of the Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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25
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West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol Health 2017; 32:1018-1036. [PMID: 28553727 PMCID: PMC5490618 DOI: 10.1080/08870446.2017.1325890] [Citation(s) in RCA: 303] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death worldwide. This paper reviews the extent and nature of harms caused by smoking, the benefits of stopping, patterns of smoking, psychological, pharmacological and social factors that contribute to uptake and maintenance of smoking, the effectiveness of population and individual level interventions aimed at combatting tobacco smoking, and the effectiveness of methods used to reduce the harm caused by continued use of tobacco or nicotine in some form. RESULTS AND CONCLUSIONS Smoking behaviour is maintained primarily by the positive and negative reinforcing properties of nicotine delivered rapidly in a way that is affordable and palatable, with the negative health consequences mostly being sufficiently uncertain and distant in time not to create sufficient immediate concern to deter the behaviour. Raising immediate concerns about smoking by tax increases, social marketing and brief advice from health professionals can increase the rate at which smokers try to stop. Providing behavioural and pharmacological support can improve the rate at which those quit attempts succeed. Implementing national programmes containing these components are effective in reducing tobacco smoking prevalence and reducing smoking-related death and disease.
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Affiliation(s)
- Robert West
- Department of Behavioural Science and Health, University College London, London, UK
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26
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Nghiem N, Cleghorn CL, Leung W, Nair N, Deen FSVD, Blakely T, Wilson N. A national quitline service and its promotion in the mass media: modelling the health gain, health equity and cost–utility. Tob Control 2017; 27:434-441. [DOI: 10.1136/tobaccocontrol-2017-053660] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 11/03/2022]
Abstract
BackgroundMass media campaigns and quitlines are both important distinct components of tobacco control programmes around the world. But when used as an integrated package, the effectiveness and cost-effectiveness are not well described. We therefore aimed to estimate the health gain, health equity impacts and cost–utility of the package of a national quitline service and its promotion in the mass media.MethodsWe adapted an established Markov and multistate life-table macro-simulation model. The population was all New Zealand adults in 2011. Effect sizes and intervention costs were based on past New Zealand quitline data. Health system costs were from a national data set linking individual health events to costs.ResultsThe 1-year operation of the existing intervention package of mass media promotion and quitline service was found to be net cost saving to the health sector for all age groups, sexes and ethnic groups (saving $NZ84 million; 95%uncertainty interval 60–115 million in the base-case model). It also produced greater per capita health gains for Māori (indigenous) than non-Māori (2.2 vs 0.73 quality-adjusted life-years (QALYs) per 1000 population, respectively). The net cost saving of the intervention was maintained in all sensitivity and scenario analyses for example at a discount rate of 6% and when the intervention effect size was quartered (given the possibility of residual confounding in our estimates of smoking cessation). Running the intervention for 20 years would generate an estimated 54 000 QALYs and $NZ1.10 billion (US$0.74 billion) in cost savings.ConclusionsThe package of a quitline service and its promotion in the mass media appears to be an effective means to generate health gain, address health inequalities and save health system costs. Nevertheless, the role of this intervention needs to be compared with other tobacco control and health sector interventions, some of which may be even more cost saving.
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27
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Berg ML, Cheung KL, Hiligsmann M, Evers S, de Kinderen RJA, Kulchaitanaroaj P, Pokhrel S. Model-based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review. Addiction 2017; 112:946-967. [PMID: 28060453 PMCID: PMC5434798 DOI: 10.1111/add.13748] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/06/2016] [Accepted: 12/30/2016] [Indexed: 12/04/2022]
Abstract
AIMS To identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context. METHODS A systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, National Health Service (NHS) Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA). The checklist-based quality of the included studies and transferability scores was based on the European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not original research, not a model-based economic evaluation, that did not consider adult population and not from a high-income country were excluded. FINDINGS Among the 64 economic evaluations included in the review, the state-transition Markov model was the most frequently used method (n = 30/64), with quality adjusted life years (QALY) being the most frequently used outcome measure in a life-time horizon. A small number of the included studies (13 of 64) were eligible for EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97, with an average score of 0.75. The average score per section was 0.69 (range = 0.35-0.92). The relative transferability of the studies could not be established due to a limitation present in the EURONHEED method. CONCLUSION All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context.
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Affiliation(s)
- Marrit L. Berg
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Kei Long Cheung
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Reina J. A. de Kinderen
- Department of Health Services Research, CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | | | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
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28
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Leung W, Roberts V, Gordon LG, Bullen C, McRobbie H, Prapavessis H, Jiang Y, Maddison R. Economic evaluation of an exercise-counselling intervention to enhance smoking cessation outcomes: The Fit2Quit trial. Tob Induc Dis 2017; 15:21. [PMID: 28360828 PMCID: PMC5371274 DOI: 10.1186/s12971-017-0126-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background In the Fit2Quit randomised controlled trial, insufficiently-active adult cigarette smokers who contacted Quitline for support to quit smoking were randomised to usual Quitline support or to also receive ≤10 face-to-face and telephone exercise-support sessions delivered by trained exercise facilitators over the 24-week trial. This paper aims to determine the cost-effectiveness of an exercise-counselling intervention added to Quitline compared to Quitline alone in the Fit2Quit trial. Methods Within-trial and lifetime cost-effectiveness were assessed. A published Markov model was adapted, with smokers facing increased risks of lung cancer and cardiovascular disease. Results Over 24 weeks, the incremental programme cost per participant in the intervention was NZ$428 (US$289 or €226; purchasing power parity-adjusted [PPP]). The incremental cost-effectiveness ratio (ICER) for seven-day point prevalence measured at 24-week follow-up was NZ$31,733 (US$21,432 or €16,737 PPP-adjusted) per smoker abstaining. However, for the 52% who adhered to the intervention (≥7 contacts), the ICER for point prevalence was NZ$3,991 (US$2,695 or €2,105 PPP-adjusted). In this adherent subgroup, the Markov model estimated 0.057 and 0.068 discounted quality-adjusted life-year gains over the lifetime of 40-year-old males (ICER: NZ$4,431; US$2,993 or €2,337 PPP-adjusted) and females (ICER: NZ$2,909; US$1,965 or €1,534 PPP-adjusted). Conclusions The exercise-counselling intervention will only be cost-effective if adherence is a minimum of ≥7 intervention calls, which in turn leads to a sufficient number of quitters for health gains. Trial registration Australasian Clinical Trials Registry Number ACTRN12609000637246
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Affiliation(s)
- William Leung
- University of Otago, Wellington, PO Box 7343, New Zealand.,University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Vaughan Roberts
- University of Auckland, Private Bag 92019, Auckland, New Zealand
| | | | | | - Hayden McRobbie
- UK Centre for Tobacco Control Studies, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Harry Prapavessis
- School of Kinesiology, Faculty of Medical and Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON Canada
| | - Yannan Jiang
- University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Ralph Maddison
- University of Auckland, Private Bag 92019, Auckland, New Zealand.,Centre for Physical Activity and Nutrition, Deakin University, Melbourne, VIC Australia
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29
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Sarkar BK, West R, Arora M, Ahluwalia JS, Reddy KS, Shahab L. Effectiveness of a brief community outreach tobacco cessation intervention in India: a cluster-randomised controlled trial (the BABEX Trial). Thorax 2017; 72:167-173. [PMID: 27708113 PMCID: PMC5284331 DOI: 10.1136/thoraxjnl-2016-208732] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Tobacco use kills half a million people every month, most in low-middle income countries (LMICs). There is an urgent need to identify potentially low-cost, scalable tobacco cessation interventions for these countries. OBJECTIVE To evaluate a brief community outreach intervention delivered by health workers to promote tobacco cessation in India. DESIGN Cluster-randomised controlled trial. SETTING 32 low-income administrative blocks in Delhi, half government authorised ('resettlement colony') and half unauthorised ('J.J. cluster') communities. PARTICIPANTS 1213 adult tobacco users. INTERVENTIONS Administrative blocks were computer randomised in a 1:1 ratio, to the intervention (16 clusters; n=611) or control treatment (16 clusters; n=602), delivered and assessed at individual level between 07/2012 and 11/2013. The intervention was single session quit advice (15 min) plus a single training session in yogic breathing exercises; the control condition comprised very brief quit advice (1 min) alone. Both were delivered via outreach, with contact made though household visits. MEASUREMENTS The primary outcome was 6-month sustained abstinence from all tobacco, assessed 7 months post intervention delivery, biochemically verified with salivary cotinine. RESULTS The smoking cessation rate was higher in the intervention group (2.6% (16/611)) than in the control group (0.5% (3/602)) (relative risk=5.32, 95% CI 1.43 to 19.74, p=0.013). There was no interaction with type of tobacco use (smoked vs smokeless). Results did not change materially in adjusted analyses, controlling for participant characteristics. CONCLUSIONS A single session community outreach intervention can increase tobacco cessation in LMIC. The effect size, while small, could impact public health if scaled up with high coverage. TRIAL REGISTRATION NUMBER ISRCTCN23362894.
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Affiliation(s)
- Bidyut K Sarkar
- Public Health Foundation of India, New Delhi, India
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Robert West
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
| | | | | | - Lion Shahab
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
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30
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Bauld L, Hiscock R, Dobbie F, Aveyard P, Coleman T, Leonardi-Bee J, McRobbie H, McEwen A. English Stop-Smoking Services: One-Year Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1175. [PMID: 27886140 PMCID: PMC5201316 DOI: 10.3390/ijerph13121175] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/08/2016] [Accepted: 11/17/2016] [Indexed: 12/02/2022]
Abstract
The UK is a global leader in stop-smoking support-providing free behavioral support and cessation medication via stop smoking services (SSS) without charge to smokers. This study aimed to explore the client and service characteristics associated with abstinence 52 weeks after quitting. A prospective cohort study of 3057 SSS clients in nine different areas of England who began their quit attempt between March 2012 and March 2013 was conducted. Important determinants of long-term quitting were assessed through quit rates and multivariable logistic regression. Our results showed that the overall weighted carbon monoxide validated quit rate for clients at 52 weeks was 7.7% (95% confidence interval (CI) 6.6-9.0). The clients of advisors, whose main role was providing stop-smoking support, were more likely to quit long-term than advisors who had a generalist role in pharmacies or general practices (odds ratio (OR) 2.3 (95% CI 1.2-4.6)). Clients were more likely to achieve abstinence through group support than one-to-one support (OR 3.4 (95% CI 1.7-6.7)). Overall, one in thirteen people who set a quit date with the National Health Service (NHS) Stop-Smoking Service maintain abstinence for a year. Improving abstinence is likely to require a greater emphasis on providing specialist smoking cessation support. Results from this study suggest that over 18,000 premature deaths were prevented through longer-term smoking cessation achieved by smokers who accessed SSS in England from March 2012 to April 2013, but outcomes varied by client characteristic and the type of support provided.
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Affiliation(s)
- Linda Bauld
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, UK.
- UK Centre for Tobacco and Alcohol Studies.
| | - Rosemary Hiscock
- UK Centre for Tobacco and Alcohol Studies.
- Department for Health, University of Bath, Bath BA2 7AY, UK.
| | - Fiona Dobbie
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, UK.
- UK Centre for Tobacco and Alcohol Studies.
| | - Paul Aveyard
- UK Centre for Tobacco and Alcohol Studies.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies.
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies.
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK.
| | - Hayden McRobbie
- UK Centre for Tobacco and Alcohol Studies.
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies.
- National Centre for Smoking Cessation and Training (NCSCT), 1 Great Western Industrial Centre, Dorchester DT1 1RD, UK.
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Dobbie F, Hiscock R, Leonardi-Bee J, Murray S, Shahab L, Aveyard P, Coleman T, McEwen A, McRobbie H, Purves R, Bauld L. Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study. Health Technol Assess 2016; 19:1-156. [PMID: 26565129 DOI: 10.3310/hta19950] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. OBJECTIVES The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. DESIGN The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. SETTING The setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services. PARTICIPANTS There were 202,804 cases included in secondary analysis and 3075 in the prospective study. INTERVENTIONS A combination of behavioural support and stop smoking medication delivered by SSS practitioners. MAIN OUTCOME MEASURES Abstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test. RESULTS Just over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have remained abstinent than those who were seen by a general practitioner (GP) practice and pharmacy providers [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2 to 4.6]. Clients who received group behavioural support (either closed or rolling groups) were three times more likely to stop smoking than those who were seen by a GP practice or pharmacy providers (OR 3.4, 95% CI 1.7 to 6.7). Satisfaction with services was high and well-being at baseline was found to be a predictor of abstinence from smoking at longer-term follow-up. Continued use of NRT at 1 year was rare, but no evidence of harm from longer-term use was identified from the data collected. CONCLUSIONS Stop Smoking Services in England are effective in helping smokers to move away from tobacco use. Using the 52-week CO-validated quit rate of 8% found in this study, we estimate that in the year 2012-13 the services supported 36,249 clients to become non-smokers for the remainder of their lives. This is a substantial figure and provides one indicator of the ongoing value of the treatment that the services provide. The study raises a number of issues for future research including (1) examining the role of electronic cigarettes (e-cigarettes) in smoking cessation for service clients [this study did not look at e-cigarette use (except briefly in the longer-term NRT study) but this is a priority for future studies]; (2) more detailed comparisons of rolling groups with other forms of behavioural support; (3) further exploration of the role of practitioner knowledge, skills and use of effective behaviour change techniques in supporting service clients to stop smoking; (4) surveillance of the impact of structural and funding changes on the future development and sustainability of SSSs; and (5) more detailed analysis of well-being over time between those who successfully stop smoking and those who relapse. Further research on longer-term use of non-combustible nicotine products that measures a wider array of biomarkers of smoking-related harm such as lung function tests or carcinogen metabolites. FUNDING The National Institute for Health Research Health Technology Assessment programme. The UK Centre for Tobacco and Alcohol Studies provided funding for the longer-term NRT study.
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Affiliation(s)
- Fiona Dobbie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
| | - Rosemary Hiscock
- UK Centre for Tobacco and Alcohol Studies, UK.,Department for Health, University of Bath, Bath, UK
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Susan Murray
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
| | - Lion Shahab
- UK Centre for Tobacco and Alcohol Studies, UK.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Paul Aveyard
- UK Centre for Tobacco and Alcohol Studies, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies, UK.,Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies, UK.,National Centre for Smoking Cessation and Training, London, UK
| | - Hayden McRobbie
- UK Centre for Tobacco and Alcohol Studies, UK.,Wolfson Institute of Preventative Medicine, Queen Mary University of London, London, UK
| | - Richard Purves
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,Department for Health, University of Bath, Bath, UK
| | - Linda Bauld
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
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West R, Shahab L, Brown J. Estimating the population impact of e-cigarettes on smoking cessation in England. Addiction 2016; 111:1118-9. [PMID: 26920514 DOI: 10.1111/add.13343] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Robert West
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Lion Shahab
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jamie Brown
- Department of Epidemiology and Public Health, University College London, London, UK
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Sohal H, Huddlestone L, Ratschen E. Preparing for Completely Smoke-Free Mental Health Settings: Findings on Patient Smoking, Resources Spent Facilitating Smoking Breaks, and the Role of Smoking in Reported Incidents from a Large Mental Health Trust in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E256. [PMID: 26927143 PMCID: PMC4808919 DOI: 10.3390/ijerph13030256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/09/2016] [Accepted: 02/15/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite high smoking prevalence and excessive smoking-related morbidity and mortality among people with mental disorder compared to the general population, smoking treatment is often neglected in mental health settings. The UK National Institute of Health and Clinical Excellence (NICE) recently issued public health guidance stipulating completely smoke-free mental health settings. This project evaluated existing smoking-related practices in preparation for guidance implementation. The objectives were to: audit the recording of smoking-related information and treatment provision; explore current arrangements relating to the facilitation of patient smoking; measure staff time spent and identify costs of facilitating smoking; and explore the role of smoking in smoking-related incidents. METHODS A mixed-methods study was conducted across four acute adult mental health wards, accommodating 16 patients each, over six months. It included a case-note audit, on-site observations, and a qualitative content analysis of incident reports. RESULTS Smoking status was recorded for less than half of the 290 patients admitted (138, 48%). Of those, 98 (71%) were recorded as current smokers, of whom 72 (74%) had received brief smoking cessation advice. Staff spent 6028 h facilitating smoking, representing an annual cost of £ 131,040 across four wards. Incident reports demonstrated that smoking facilitation was often central to the cause of incidences, triggered frustration in patients, and strained staff resources. CONCLUSION The findings highlight the importance and potential of implementing completely smoke-free policies using comprehensive pathways.
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Affiliation(s)
- Harpreet Sohal
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology & Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
| | - Lisa Huddlestone
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology & Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
| | - Elena Ratschen
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology & Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
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Higgins ST, Solomon LJ. Some Recent Developments on Financial Incentives for Smoking Cessation Among Pregnant and Newly Postpartum Women. CURRENT ADDICTION REPORTS 2016; 3:9-18. [PMID: 27158581 DOI: 10.1007/s40429-016-0092-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Smoking during pregnancy is a leading preventable cause of poor pregnancy outcomes and immediate and longer-term adverse health outcomes among exposed offspring. Developing more effective smoking-cessation interventions for pregnant women has been a public-health priority for more than thirty years. We review developments over the past three years (2012-15) on the use of financial incentives to promote smoking cessation among pregnant women. We searched the literature for reports on primary and secondary analyses and reviews of controlled trials on this topic published in peer-reviewed journals using the search engine PubMed, reviewed bibliographies of published articles, and consulted expert colleagues. The search revealed several important developments, with the following three being especially noteworthy. First, the review identified four new randomized controlled trials, three of which further supported the efficacy of this treatment approach. One of the three trials supporting efficacy also included the first econometric analysis of this treatment approach showing financial incentives with pregnant smokers to be highly cost-effective. Second, two Cochrane reviews were published during this 3-year period covering the more recent and earlier efficacy trials. Meta-analyses in both reviews supported the efficacy of the approach. Lastly, the first effectiveness trial was reported demonstrating that financial incentives increased abstinence rates above control levels when implemented by obstetrical clinic staff in a large urban hospital working with community tobacco interventionists. Overall, there is a growing and compelling body of evidence supporting the efficacy and cost-effectiveness of financial incentives for smoking cessation among pregnant women.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont; Department of Psychiatry, University of Vermont; Department of Psychological Science, University of Vermont
| | - Laura J Solomon
- Department of Psychological Science, University of Vermont; Department of Family Practice, University of Vermont
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Tosanguan J, Chaiyakunapruk N. Cost-effectiveness analysis of clinical smoking cessation interventions in Thailand. Addiction 2016; 111:340-50. [PMID: 26360507 DOI: 10.1111/add.13166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/27/2014] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
Abstract
AIMS Clinical smoking cessation interventions have been found typically to be highly cost-effective in many high-income countries. There is a need to extend this to low- and middle-income countries and undertake comparative analyses. This study aimed to estimate the incremental cost-effectiveness ratio of a range of clinical smoking cessation interventions available in Thailand. METHODS Using a Markov model, cost-effectiveness, in terms of cost per quality-adjusted life years (QALY) gained, from a range of interventions was estimated from a societal perspective for males and females aged 40 years who smoke at least 10 cigarettes per day. Interventions considered were: counselling in hospital, phone counselling (Quitline) and counselling plus nicotine gum, nicotine patch, bupropion, nortriptyline or varenicline. An annual discounting rate of 3% was used. Probabilistic sensitivity analyses were conducted and a cost-effectiveness acceptability curve (CEAC) plotted. Comparisons between interventions were conducted involving application of a 'decision rule' process. RESULTS Counselling with varenicline and counselling with nortriptyline were found to be cost-effective. Hospital counselling only, nicotine patch and bupropion were dominated by Quitline, nortriptyline and varenicline, respectively, according to the decision rule. When compared with unassisted cessation, probabilistic sensitivity analysis revealed that all interventions have very high probabilities (95%) of being cost-saving except for nicotine replacement therapy (NRT) patch (74%). CONCLUSION In middle-income countries such as Thailand, nortriptyline and varenicline appear to provide cost-effective clinical options for supporting smokers to quit.
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Affiliation(s)
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.,Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, University of Wisconsin, Madison, USA.,School of Population Health, University of Queensland, Brisbane, Australia
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Boyd KA, Briggs AH, Bauld L, Sinclair L, Tappin D. Are financial incentives cost-effective to support smoking cessation during pregnancy? Addiction 2016; 111:360-70. [PMID: 26370095 DOI: 10.1111/add.13160] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/03/2015] [Accepted: 09/07/2015] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the cost-effectiveness of up to £400 worth of financial incentives for smoking cessation in pregnancy as an adjunct to routine health care. DESIGN Cost-effectiveness analysis based on a Phase II randomized controlled trial (RCT) and a cost-utility analysis using a life-time Markov model. SETTING The RCT was undertaken in Glasgow, Scotland. The economic analysis was undertaken from the UK National Health Service (NHS) perspective. PARTICIPANTS A total of 612 pregnant women randomized to receive usual cessation support plus or minus financial incentives of up to £400 vouchers (US $609), contingent upon smoking cessation. MEASUREMENTS Comparison of usual support and incentive interventions in terms of cotinine-validated quitters, quality-adjusted life years (QALYs) and direct costs to the NHS. FINDINGS The incremental cost per quitter at 34-38 weeks pregnant was £1127 ($1716).This is similar to the standard look-up value derived from Stapleton & West's published ICER tables, £1390 per quitter, by looking up the Cessation in Pregnancy Incentives Trial (CIPT) incremental cost (£157) and incremental 6-month quit outcome (0.14). The life-time model resulted in an incremental cost of £17 [95% confidence interval (CI) = -£93, £107] and a gain of 0.04 QALYs (95% CI = -0.058, 0.145), giving an ICER of £482/QALY ($734/QALY). Probabilistic sensitivity analysis indicates uncertainty in these results, particularly regarding relapse after birth. The expected value of perfect information was £30 million (at a willingness to pay of £30 000/QALY), so given current uncertainty, additional research is potentially worthwhile. CONCLUSION Financial incentives for smoking cessation in pregnancy are highly cost-effective, with an incremental cost per quality-adjusted life years of £482, which is well below recommended decision thresholds.
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Affiliation(s)
- Kathleen A Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Andrew H Briggs
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Linda Bauld
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| | - Lesley Sinclair
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| | - David Tappin
- Paediatric Epidemiology and Community Health Unit, University of Glasgow, Glasgow, UK
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West R, Raw M, McNeill A, Stead L, Aveyard P, Bitton J, Stapleton J, McRobbie H, Pokhrel S, Lester‐George A, Borland R. Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction 2015; 110:1388-403. [PMID: 26031929 PMCID: PMC4737108 DOI: 10.1111/add.12998] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 03/10/2015] [Accepted: 05/22/2015] [Indexed: 12/11/2022]
Abstract
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. 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. 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. 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.
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Affiliation(s)
- Robert West
- Cancer Research UK Health Behaviour Research CentreUniversity College LondonLondonUK
| | - Martin Raw
- Special Lecturer, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Ann McNeill
- Professor of Tobacco Addiction, King's College London, UK Centre for Tobacco and Alcohol StudiesNational Addiction CentreLondonUK
| | - Lindsay Stead
- Cochrane Tobacco Addiction Group, Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Paul Aveyard
- Professor of Behavioural Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory QuarterUniversity of OxfordOxfordUK
| | - John Bitton
- Professor of Epidemiology, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - John Stapleton
- Reader in Addiction Statistical Analysis, Addictions Department, Institute of PsychiatryKings College LondonLondonUK
| | - Hayden McRobbie
- Reader in Public Health Interventions, Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | | | - Ron Borland
- Cancer Council Victoria, Melbourne, VictoriaAustralia
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Stapleton JA. Cytisine is more effective than nicotine replacement for smoking cessation. EVIDENCE-BASED MEDICINE 2015; 20:130. [PMID: 25935656 DOI: 10.1136/ebmed-2015-110188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- John A Stapleton
- Department of Addiction, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Ferguson SG, Brown J, Frandsen M, West R. Associations between use of pharmacological aids in a smoking cessation attempt and subsequent quitting activity: a population study. Addiction 2015; 110:513-8. [PMID: 25393225 DOI: 10.1111/add.12795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 09/22/2014] [Accepted: 10/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Modelling the population impact and cost-effectiveness of smoking cessation aids is limited by lack of knowledge about how the use of aids changes across quit attempts. Here we test whether the quit method used in a previous attempt influences (i) future decisions to quit and/or (ii) treatment/s used during subsequent attempts. DESIGN AND SETTING Data came from the Smoking Toolkit Study, a United Kingdom national household survey. PARTICIPANTS AND MEASURES Smokers (n = 5489) who completed a baseline and 6-month follow-up questionnaire. Respondents were asked what treatment/s, grouped as: prescription medication/s [bupropion, varenicline or nicotine replacement therapy (NRT)], over-the-counter NRT or unaided that they had used in their most recent quit attempt (at baseline), and any use of treatment/s for a quit attempt in the last 3 months at follow-up. RESULTS Smokers who had tried to quit at baseline were more likely to report having tried to quit again prior to follow-up [all odds ratios ≥ 2.19 relative to no attempt at baseline, P < 0.001]. Smokers who tried to quit using pharmacological aids were more likely to try to quit again at follow-up (all ORs ≥ 2.19 relative to no attempt at baseline, P < 0.001). Smokers tended to re-try aids used in baseline attempts in future attempts (all ORs ≥ 1.48 relative to no attempt at baseline, P < 0.01). CONCLUSIONS Smokers who have tried to quit in the past year are more likely to try to quit again within 6 months regardless of whether they used a pharmacological aid, and they are more likely to re-try aids they had used previously.
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Combining intensive practice nurse counselling or brief general practitioner advice with varenicline for smoking cessation in primary care: study protocol of a pragmatic randomized controlled trial. Contemp Clin Trials 2015; 41:298-312. [PMID: 25657051 DOI: 10.1016/j.cct.2015.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Combining behavioural support and pharmacotherapy is most effective for smoking cessation and recommended in clinical guidelines. Despite that smoking cessation assistance from the general practitioner can be effective, dissemination of clinical practice guidelines and efforts on upskilling has not lead to the routine provision of smoking cessation advice among general practitioners. Intensive counselling from the practice nurse could contribute to better smoking cessation rates in primary care. However, the effectiveness of intensive counselling from a practice nurse versus usual care from a general practitioner in combination with varenicline is still unknown. MATERIALS AND METHODS A pragmatic randomized controlled trial was conducted comparing: (a) intensive individual counselling delivered by a practice nurse and (b) brief advice delivered by a general practitioner; both groups received 12-weeks of open-label varenicline. A minimum of 272 adult daily smoking participants were recruited and treated in their routine primary care setting. The primary outcome was defined as prolonged abstinence from weeks 9 to 26, biochemically validated by exhaled carbon monoxide. Data was analysed blinded according to the intention-to-treat principle and participants with missing data on their smoking status at follow-up were counted as smokers. Secondary outcomes included: one-year prolonged abstinence, short-term incremental cost-effectiveness, medication adherence, and baseline predictors of successful smoking cessation. DISCUSSION This trial is the first to provide scientific evidence on the effectiveness, cost-effectiveness, and potential mechanisms of action of intensive practice nurse counselling combined with varenicline under real-life conditions. This paper explains the methodology of the trial and discusses the pragmatic and/or explanatory design aspects. TRIAL REGISTRATION Dutch Trial Register NTR3067.
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Walker N, Howe C, Glover M, McRobbie H, Barnes J, Nosa V, Parag V, Bassett B, Bullen C. Cytisine versus nicotine for smoking cessation. N Engl J Med 2014; 371:2353-62. [PMID: 25517706 DOI: 10.1056/nejmoa1407764] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Placebo-controlled trials indicate that cytisine, a partial agonist that binds the nicotinic acetylcholine receptor and is used for smoking cessation, almost doubles the chances of quitting at 6 months. We investigated whether cytisine was at least as effective as nicotine-replacement therapy in helping smokers to quit. METHODS We conducted a pragmatic, open-label, noninferiority trial in New Zealand in which 1310 adult daily smokers who were motivated to quit and called the national quitline were randomly assigned in a 1:1 ratio to receive cytisine for 25 days or nicotine-replacement therapy for 8 weeks. Cytisine was provided by mail, free of charge, and nicotine-replacement therapy was provided through vouchers for low-cost patches along with gum or lozenges. Low-intensity, telephone-delivered behavioral support was provided to both groups through the quitline. The primary outcome was self-reported continuous abstinence at 1 month. RESULTS At 1 month, continuous abstinence from smoking was reported for 40% of participants receiving cytisine (264 of 655) and 31% of participants receiving nicotine-replacement therapy (203 of 655), for a difference of 9.3 percentage points (95% confidence interval, 4.2 to 14.5). The effectiveness of cytisine for continuous abstinence was superior to that of nicotine-replacement therapy at 1 week, 2 months, and 6 months. In a prespecified subgroup analysis of the primary outcome, cytisine was superior to nicotine-replacement therapy among women and noninferior among men. Self-reported adverse events over 6 months occurred more frequently in the cytisine group (288 events among 204 participants) than in the group receiving nicotine-replacement therapy (174 events among 134 participants); adverse events were primarily nausea and vomiting and sleep disorders. CONCLUSIONS When combined with brief behavioral support, cytisine was found to be superior to nicotine-replacement therapy in helping smokers quit smoking, but it was associated with a higher frequency of self-reported adverse events. (Funded by the Health Research Council of New Zealand; Australian New Zealand Clinical Trials Registry number, ACTRN12610000590066.).
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Affiliation(s)
- Natalie Walker
- From the National Institute for Health Innovation (N.W., C.H., V.P., C.B.), the Centre for Tobacco Control Research, Department of Social and Community Health (M.G.), the Department of Pacific Health (V.N.) and the School of Population Health and the School of Pharmacy (J.B.), University of Auckland, Auckland, and the Quit Group, Wellington (B.B.) - all in New Zealand; and Queen Mary University of London, Wolfson Institute of Preventive Medicine, and UK Centre for Tobacco and Alcohol Studies, Barts and the London School of Medicine and Dentistry - all in London (H.M.)
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Brose LS, West R, Michie S, McEwen A. Changes in success rates of smoking cessation treatment associated with take up of a national evidencebased training programme. Prev Med 2014; 69:1-4. [PMID: 25152508 DOI: 10.1016/j.ypmed.2014.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/26/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The English 'stop smoking services' provide behavioural support to some 700,000 smokers annually. Success rates of the services varied considerably before 2010 and had been in slight decline so, to improve performance, a national programme of evidence-based practitioner training was developed to improve knowledge and skills-based competences. This study evaluated whether uptake of the training was associated with improvements in success rates of services. METHODS Mean 4-week biochemically verified abstinence rates were compared for 146 (of 151) stop smoking services between 2008-10 (before roll-out of training) and 2011-13 (after roll-out), and the change in success rates for each service was regressed on to the number of practitioners per service trained in a) knowledge (online) and b) skills (face-to-face). RESULTS Success rate across all services improved between the two periods (34.1% to 36.5%, p=0.01 1-tailed; 95% CI for difference 0.44-4.48). The magnitude of improvement for each service was associated with the number of practitioners who completed the knowledge and skills training (beta=0.22, p=0.005 1-tailed), and marginally with the number who completed the knowledge training (beta=0.14, p=0.047 1-tailed). CONCLUSION English stop smoking services that have greater uptake of a national evidence-based training programme showed greater improvements in success rates.
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Affiliation(s)
- Leonie S Brose
- UK Centre for Tobacco and Alcohol Studies, Addictions, Institute of Psychiatry, King's College London, UK.
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, UK; National Centre for Smoking Cessation and Training (NCSCT), UK
| | - Susan Michie
- Clinical, Educational and Health Psychology, University College London, UK; National Centre for Smoking Cessation and Training (NCSCT), UK
| | - Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, UK; National Centre for Smoking Cessation and Training (NCSCT), UK
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Hsueh KC, Hsueh SC, Chou MY, Pan LF, Tu MS, McEwen A, West R. Varenicline versus transdermal nicotine patch: a 3-year follow-up in a smoking cessation clinic in Taiwan. Psychopharmacology (Berl) 2014; 231:2819-23. [PMID: 24522334 DOI: 10.1007/s00213-014-3482-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE A network meta-analysis of randomized trials and real-world comparative studies strongly suggest that varenicline is more effective in aiding smoking cessation than single form nicotine replacement therapy (NRT). Modeling the health benefits attributable to this difference relies on extrapolation to lifetime cessation, but to date, follow-up has only extended to 12 months. Longer term follow-up data are helpful in checking these assumptions. OBJECTIVES This study aimed to compare the sustained abstinence rates of smokers using varenicline versus nicotine patch in their quit attempt up to 36 months. METHOD Five hundred eighty-seven smokers were recruited at Kaohsiung Veteran General Hospital between Feb 2006 and Aug 2009. Participants received counseling from a physician and received either varenicline (N=296) or the nicotine patch (N=291) for smoking cessation. Both varenicline and nicotine patch users could receive their medications for a maximum of 8 weeks. Participants were followed up by telephone at 3, 6, 12, and 36 months from the first visit. The primary outcome measure was self-reported sustained abstinence up to 36 months. Measures were also taken of smoking characteristics, cigarette dependence, and sociodemographic characteristics. RESULTS Multiple logistic regression of 36-month sustained abstinence on to medication adjusting for other baseline variables showed a significant advantage for varenicline, OR=7.94 (95 % CI 1.87-33.74). CONCLUSION An 8-week course of varenicline appears to yield higher abstinence rate up to 3 years than a similar length course of nicotine transdermal patch in routine clinical practice where behavioral support is available.
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Affiliation(s)
- Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung, 813, Taiwan,
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Barnett PG, Wong W, Jeffers A, Munoz R, Humfleet G, Hall S. Cost-effectiveness of extended cessation treatment for older smokers. Addiction 2014; 109:314-22. [PMID: 24329972 PMCID: PMC4020783 DOI: 10.1111/add.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/21/2012] [Accepted: 10/24/2013] [Indexed: 11/30/2022]
Abstract
AIMS We examined the cost-effectiveness of extended smoking cessation treatment in older smokers. DESIGN Participants who completed a 12-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy. SETTING A free-standing smoking cessation clinic. PARTICIPANTS A total of 402 smokers aged 50 years and older were recruited from the community. MEASUREMENTS The trial measured biochemically verified abstinence from cigarettes after 2 years and the quantity of smoking cessation services utilized. Trial findings were combined with literature on changes in smoking status and the age- and gender-adjusted effect of smoking on health-care cost, mortality and quality of life over the long term in a Markov model of cost-effectiveness over a lifetime horizon. FINDINGS The addition of extended cognitive behavioral therapy added $83 in smoking cessation services cost [P = 0.012, confidence interval (CI) = $22-212]. At the end of follow-up, cigarette abstinence rates were 50.0% with extended cognitive behavioral therapy and 37.2% without this therapy (P < 0.05, odds ratio 1.69, CI 1.18-2.54). The model-based incremental cost-effectiveness ratio was $6324 per quality-adjusted life year (QALY). Probabilistic sensitivity analysis found that the additional $947 in lifetime cost of the intervention had a 95% confidence interval of -$331 to 2081; the 0.15 additional QALYs had a confidence interval of 0.035-0.280, and that the intervention was cost-effective against a $50 000/QALY acceptance criterion in 99.6% of the replicates. Extended nicotine replacement therapy was not cost-effective. CONCLUSIONS Adding extended cognitive behavior therapy to standard cessation treatment was cost-effective. Further intensification of treatment may be warranted.
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Affiliation(s)
- Paul G. Barnett
- Department of Psychiatry, University of California, San Francisco
,Veterans Affairs Health Economics Resource Center and Stanford University
| | - Wynnie Wong
- Department of Psychiatry, University of California, San Francisco
| | - Abra Jeffers
- Veterans Affairs Health Economics Resource Center and Stanford University
| | - Ricardo Munoz
- Department of Psychiatry, University of California, San Francisco
,Palo Alto University
| | - Gary Humfleet
- Department of Psychiatry, University of California, San Francisco
| | - Sharon Hall
- Department of Psychiatry, University of California, San Francisco
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Brown J, Kotz D, Michie S, Stapleton J, Walmsley M, West R. How effective and cost-effective was the national mass media smoking cessation campaign 'Stoptober'? Drug Alcohol Depend 2014; 135:52-8. [PMID: 24322004 PMCID: PMC3929003 DOI: 10.1016/j.drugalcdep.2013.11.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/31/2013] [Accepted: 11/01/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND A national smoking cessation campaign based on behaviour change theory and operating through both traditional and new media was launched across England during late 2012 ('Stoptober'). In addition to attempting to start a movement in which smokers would quit at the same time in response to a positive mass quitting trigger, the campaign set smokers the goal of being smoke-free for October and embodied other psychological principles in a range of tools and communications. METHODS Data on quit attempts were obtained from 31,566 past-year smokers during nationally representative household surveys conducted monthly between 2007 and 2012. The effectiveness of the campaign was assessed by the increase in national quit attempt rate in October relative to other months in 2012 vs. 2007-2011. RESULTS Relative to other months in the year, more people tried to quit in October in 2012 compared with 2007-2011 (OR=1.79, 95%CI=1.20-2.68). In 2012 there was an approximately 50% increase in quitting during October compared with other months of the same year (9.6% vs. 6.6%; OR=1.50, 95%CI=1.05-2.15), whereas in 2007-2011 the rate in October was non-significantly less than in other months of the same period (6.4% vs. 7.5%; OR=0.84, 95%CI=0.70-1.00). Stoptober is estimated to have generated an additional 350,000 quit attempts and saved 10,400 discounted life years (DLY) at less than £415 per DLY in the modal age group. CONCLUSIONS Designing a national public health campaign with a clear behavioural target (making a serious quit attempt) using key psychological principles can yield substantial behaviour change and public health impact.
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Affiliation(s)
- Jamie Brown
- Cancer Research UK Health Behaviour Research Centre, University College London, London WC1E 6BT, UK.
| | - Daniel Kotz
- Cancer Research UK Health Behaviour Research Centre, University College London, London WC1E 6BT, UK,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK,National Centre for Smoking Cessation and Training, London, UK
| | - John Stapleton
- Addictions Department, Institute of Psychiatry, Kings College London, London, UK
| | | | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London WC1E 6BT, UK,National Centre for Smoking Cessation and Training, London, UK
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The effects of noncontingent and self-administered cytisine on body weight and meal patterns in male Sprague-Dawley rats. Pharmacol Biochem Behav 2013; 110:192-200. [PMID: 23876236 DOI: 10.1016/j.pbb.2013.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 07/02/2013] [Accepted: 07/13/2013] [Indexed: 01/30/2023]
Abstract
RATIONALE Increased appetite and weight gain after cessation are deterrents for quitting smoking. Pharmacotherapies that can reduce this weight gain in ex-smokers would be invaluable, and yet are not well studied in this context. OBJECTIVE To examine the effects of extended daily exposure to intravenous cytisine, an alpha4beta2 nAChR partial agonist used for smoking cessation in some European countries, on body weight and patterns of food intake in rats. METHODS In the first experiment, programmed infusions of cytisine were administered over 15 h per day. Food intake, meal patterns, and weight change were examined relative to a vehicle-infused group during treatment, and in a post-cytisine phase. The second experiment examined the effects of cytisine on food intake, meal patterns, and weight change when substituted for nicotine in a self-administration protocol. Rats self-administered nicotine and cytisine during alternating four day periods, and changes in body weight, drug infusions, and meal patterns were compared between drugs and during an extinction phase. RESULTS In the first experiment, cytisine-treated rats ate less and gained less weight than those that received the vehicle. This occurred primarily by a reduced frequency of meals. In the 12 day post-cytisine phase, animals maintained a lower body weight relative to controls throughout. In the second experiment, total pellet intake increased during cytisine substitution relative to nicotine and animals self-administered cytisine significantly less than nicotine. However, cytisine substitution maintained decreases in food intake and weight gain compared to baseline via decreases in total pellet intake and meal size. CONCLUSION Cytisine administration results in decreased weight gain and changes in meal patterns dependent upon mode and pattern of administration and a previous history of nicotine administration.
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Holman LR, Bricker JB, Comstock BA. Psychological predictors of male smokeless tobacco use initiation and cessation: a 16-year longitudinal study. Addiction 2013; 108:1327-35. [PMID: 23607490 PMCID: PMC3679343 DOI: 10.1111/add.12164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/12/2012] [Accepted: 02/15/2013] [Indexed: 11/29/2022]
Abstract
AIMS To test whether psychological factors predict male smokeless tobacco (SLT) initiation and cessation longitudinally. DESIGN Sixteen-year longitudinal design with 95% retention at year 6 and 82% at year 16. SETTING Forty Washington State school districts. PARTICIPANTS SLT use data were gathered on a cohort of adolescents (91% Caucasian). For SLT initiation, the sample size was 2468. For SLT cessation, sample sizes were 219 (age 20 outcome) and 192 (age 28 outcome). MEASUREMENTS Self-reported psychological measures of parental disobedience ('parent non-compliance'), peer influence ('friend compliance'), rebelliousness and thrill-seeking were taken at ages 12 and 18. SLT use was measured at ages 12, 18, 20 and 28 years. FINDINGS For SLT initiation, scoring highly on the following psychological factors at age 12 at least doubled the odds of daily SLT use at age 18 (P < 0.001): friend compliance [odds ratio (OR): 2.56, 95% confidence interval (CI): 1.78-3.68), rebelliousness (OR: 2.16, 95% CI: 1.46-3.19) and thrill-seeking (OR: 2.33, 95% CI: 1.45-3.75). For SLT cessation, none of the psychological factors at age 18 predicted SLT cessation at age 20 or 28 (P value range: 0.06-0.84). CONCLUSION Peer influence, rebelliousness, and thrill-seeking appear to predict smokeless tobacco initiation strongly among male youth in the United States.
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Affiliation(s)
- Leela R. Holman
- Cancer Prevention Research Program, Division of Public Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States,Department of Psychology, University of Washington, Seattle, Washington, United States
| | - Jonathan B. Bricker
- Cancer Prevention Research Program, Division of Public Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States,Department of Psychology, University of Washington, Seattle, Washington, United States
| | - Bryan A. Comstock
- Cancer Prevention Research Program, Division of Public Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States,Department of Biostatistics, University of Washington, Seattle, Washington, United States
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Olano-Espinosa E, Matilla-Pardo B, Minue C, Anton E, Gomez-Gascon T, Ayesta FJ. Effectiveness of a Health Professional Training Program for Treatment of Tobacco Addiction. Nicotine Tob Res 2013; 15:1682-9. [DOI: 10.1093/ntr/ntt040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Brose LS, West R, Stapleton JA. Comparison of the effectiveness of varenicline and combination nicotine replacement therapy for smoking cessation in clinical practice. Mayo Clin Proc 2013; 88:226-33. [PMID: 23489449 DOI: 10.1016/j.mayocp.2012.11.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/19/2012] [Accepted: 11/21/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the effectiveness of varenicline and combination nicotine replacement therapy (NRT) for treating smokers attempting to stop, as it is unclear which of the 2 is more effective. PATIENTS AND METHODS Data from 167,487 treatment episodes in patients from 42 National Health Service Stop Smoking Services (April 1, 2009, through June 30, 2011) using varenicline or combination NRT were analyzed. The outcome was carbon monoxide-validated 4-week smoking abstinence. Potential predictors were age, sex, occupational grade, exemption from prescription charges, intervention setting (specialist or other), support (group or other), and year of quit attempt. RESULTS Observed smoking abstinence rates were higher with varenicline (43.5% vs 36.9%). However, there was evidence of systematic variation in medication effect across clinical services and differences in predictors of outcome between medications. Allowing for these influences indicated a small mean advantage for varenicline (odds ratio, 1.080; 95% CI, 1.003-1.163; difference, 1.86%; 95% CI, 0.07%-3.67%; P=.04). The relative effectiveness of the 2 medications was not moderated by setting, type of support, or year. CONCLUSION The relative effect of medication varies substantially according to clinical practice and population treated. Averaged across current English clinical practice and populations, varenicline is marginally more effective than combination NRT. Demographic and intervention characteristics associated with success predict varenicline use.
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Affiliation(s)
- Leonie S Brose
- National Centre for Smoking Cessation and Training and Department of Clinical, Educational, and Health Psychology, University College London, London, England.
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