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

Abstract

© 2015 The Authors. Aims This paper provides a concise review of the efficacy, effectiveness and affordability of healthcare 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 randomised controlled trials (RCTs) of major healthcare 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 likely 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 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 healthcare worker given opportunistically to smokers attending healthcare 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 healthcare worker, telephone helplines, automated text messaging, printed self-help materials, cytisine and nortriptyline are globally affordable healthcare interventions to promote and assist smoking cessation. Evidence on smokeless tobacco cessation suggests that face-to-face behavioural support and varenicline can promote cessation. This article is protected by copyright. All rights reserved.