'Cut down to quit' with nicotine replacement therapies in smoking cessation: a systematic review of effectiveness and economic analysis

Abstract

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Assessing the outcomes of prolonged cessation-induction and aid-to-cessation trials: Floating prolonged abstinence

“…The NARS trials enrolled smokers who did not intend to quit imminently, and the primary goal was reduction. Somewhat unexpectedly, the treatment led to a doubling of long-term abstinence rates; hence, the NRT products tested were licensed for reducing to stop ( Wang et al, 2008 ). We speculate that the NRT improved the experience of reducing and eventually stopping smoking so that the smoker who felt unable to stop without NRT felt that it was possible with NRT, although the reason for the effi cacy of NRT in these trials is unknown.…”

“…It seems unlikely that participants recruited based on their not intending to stop smoking in the next month would begin a cessation attempt within 6 weeks of making such a statement. Consequently, such outcomes were rare (occurring in 1.6% of those in the NRT arm; Wang et al, 2008 ), and trials using this outcome as the primary one would need to be unfeasibly large to show a difference in abstinence between arms. These studies treated smokers for up to 18 months with a view to inducing abstinence throughout that period.…”

“…In turn, lifetime abstinence can be converted into QALY gain ( Wang et al, 2008 ). However, in typical aid-to-cessation studies, we can anchor the start of the prolonged abstinence to the start of quitting, which is close to the start of the treatment.…”

“…This fi nding has two consequences for such a trial. The sample size is infl ated because the outcome (6-to 18-month abstinence) is less frequent than is 6-month abstinence, and, in health economic assessment, lifetime abstinence is the true outcome of interest ( Wang et al, 2008 ). Abstinence lasting 6 -18 months is hard to convert to lifetime abstinence because this mixture of abstinence periods makes relapse rates harder to model.…”

“…We reviewed these trials recently ( Wang et al, 2008 ). In this process, we examined the outcomes used in the trials, which were based on the recommendations of the SRNT working group ( Hughes et al, 2003 ).…”