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

Abstract

AimsThis 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.MethodsCochrane 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.ResultsBrief 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.ConclusionsBrief 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.

Evaluating clinical stop‐smoking services globally: towards a minimum data set

“…This is partly because of increasing prevalence in other countries and partly because of population growth. Some of these users may be able to stop when they choose, but the success rates of unaided quit attempts 2 and findings from clinical trials and population studies 3 indicate that most would benefit from support in their attempt to stop smoking. Article 14 of the World Health Organization Framework Convention on Tobacco Control (FCTC) requires Parties to take effective measures to promote tobacco use cessation and adequate treatment for tobacco dependence.…”

A survey of tobacco dependence treatment guidelines content in 61 countries

“…A third recommend text messaging, the evidence base for which has grown since the last survey 12, 13, which illustrates the need for countries to update their guidelines periodically in order to reflect the evidence base, something clearly recommended in the FCTC Article 14 guidelines.…”

“…However, national guidelines must be, by definition, for the country's own health‐care system, and must reflect the resources available. Tools are now available to help countries write or update their guidelines, including a library of national guidelines 15 and a review of the evidence base written especially for guideline development, which includes an affordability calculator for use within a country, using national data 13. This review was used by New Zealand to update their guidelines 11, and could serve as a simple and affordable approach other countries could adopt.…”

Assessment of cost‐effective changes to the current and potential provision of smoking cessation services: an analysis based on the EQUIPTMOD

“…26 showed that the services were effective in successfully people to stop smoking supporting in the short‐ and long terms. Another systematic review by West and colleagues 18 suggested that smoking cessation services are also effective and affordable in middle‐ and high‐income countries 8. However, it was less clear whether these interventions when implemented collectively (current practice) would be as cost‐effective as when the current provision is reorganized to improve the reach and cut costs.…”

“…Good‐quality evidence around the effectiveness and cost‐effectiveness of interventions used in the current provision of smoking cessation services is available 8. However, it is less clear whether reorganizing the current provision, with an aim to achieving efficiency savings or improving reach, would deliver a better return on investment.…”