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GP, general practitioner; NRT, nicotine replacement therapy.

GP, general practitioner; NRT, nicotine replacement therapy.

Is smoking cessation work worthwhile?

Various interventions to assist smoking cessation have been assessed as shown in Table 8.2, with success in each case being defined as 6months or more of tobacco abstinence. It will seen from the Table that in properly validated studies, success rates increase with the amount of support given. Success also increases (roughly doubles) with NRT or bupropion, and with the motivation of the smoker—those who seek help are more likely to succeed than those who come to a doctor for another reason, or who are admitted to hospital. Bearing in mind the number of smokers (in the UK, perhaps 13 million out of a population of 55 million), even these apparently small success rates can represent large numbers of people.

A further way of looking at the issue of smoking cessation is by the benefit achieved in terms of life-years saved by successful smoking interventions. This issue is examined extensively in the British smoking cessation guidelines [3,4] but it has been calculated that an intervention based on an integrated area service and including brief advice, self-help, nicotine replacement therapy and a specialist service costs about £873 per quality-adjusted life year (QALY) saved. The cost of brief advice only is just over £2000 per QALY. Although this may sound expensive, many other forms of therapy are very much more expensive; for instance, the use of lipid-lowering agents (statins) has been estimated to cost around £9000 per QALY. It is estimated that £275million will be spent on statins in the year 2001 —about 10 times as much as is likely to be spent on smoking cessation drugs, with less than a tenth of the cost-effectiveness.

References

1 Anthonisen NR, Connet JE, Kiley JP et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. JAMA 1994; 272: 1497-505.

2 Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 1991; 86: 1119-27.

3 Raw M, McNeill A, West R. Smoking cessation guidelines for health professionals. Thorax 1998; 53: S1-38.

4 West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Thorax 2000; 55: 987-99.

Further reading

• Cochrane Tobacco Addiction Group.

Cochrane Library, Issue 4, 2001.

• Royal College of Physicians of London.

Nicotine Addiction in Britain. London: Royal College of Physicians, 2000.

• Royal College of Nursing. Clearing the air:

a nurse's guide to smoking and tobacco control. London: Royal College of Nursing, 1999.

• US Department of Health and Human

Services. Treating Tobacco Use and dependence Clinical Practice Guideline, 2000.

Valuable Internet sites

• Ash Scotland: http:/www.ashscotland.org.uk

• Society for Research on Nicotine and Tobacco (SRNT): http:/www.treatobacco.net

• The Quit Guide to Stopping Smoking: http:/healthnet.org.uk/quit/guide.htm

Telephone quit lines (UK telephone numbers)

• Quit: 0800-002200 (also has other lines for Asian languages and Turkish and Kurdish speakers)

• Scottish Smokeline: 0800-848484.

Ash UK: http:7www.ash.org.uk

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