The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences

Chapman, Simon; MacKenzie, Ross

doi:10.1371/journal.pmed.1000216

Cited by 215 publications

(210 citation statements)

References 59 publications

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“…At the individual level, providers would be well served by realistic expectations when prescribing medications: clinicians could plan from the outset to continue to intervene over time. Identification of the decline in benefit over time is also useful at the population level: it contributes to understanding of the lack of clear population‐level impact of smoking cessation medications in societies 21, 36, 37, 39, 40, 41, 42, 43 and highlights the importance of relapse prevention at both clinical and societal levels.…”

Section: Discussionmentioning

confidence: 99%

Diminishing benefit of smoking cessation medications during the first year: a meta‐analysis of randomized controlled trials

et al. 2018

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Background and aimsAlthough smoking cessation medications have shown effectiveness in increasing abstinence in randomized controlled trials (RCTs), it is unclear to what extent benefits persist over time. This paper assesses whether the benefits of smoking cessation medications decline over the first year.MethodsWe selected studies from three systematic reviews published by the Cochrane Collaboration. RCTs of first‐line smoking cessation medications, with 6‐ and 12‐month follow‐up, were eligible for inclusion. Meta‐analysis was used to synthesize information on sustained abstinence (SA) at 6 versus 12 months and 3 versus 6 months, using the risk difference (RD) (‘net benefit’) between intervention and control group quit rates, the relative risk (RR) and the odds ratio (OR).ResultsSixty‐one studies (27 647 participants) were included. Fewer than 40% of intervention group participants were sustained abstinent at 3 months (bupropion: 37.1%; nicotine replacement therapy (NRT): 34.8%; varenicline: 39.3%); approximately a quarter were sustained abstinent at 6 months (bupropion: 25.9%; NRT: 26.6%; varenicline: 25.4%), and approximately a fifth were sustained abstinent at 12 months (bupropion: 19.9%; NRT: 19.8%%; varenicline: 18.7%). There was only a small decline in RR (3 months: 1.95 [95% confidence interval (CI) = 1.74–2.18, P < 0.0001]; 6 months: 1.87 (95% CI = 1.67–2.08 P < 0.0001); 12 months: 1.75 (95% CI = 1.56–1.95, P < 0.0001) between intervention and control groups over time, but a substantial decline in net benefit [3 months: RD = 17.3% (14.5–20.1%); 6 months: RD = 11.8% (10.0–13.7%); 12 months: RD = 8.2% (6.8–9.6%)]. The decline in net benefit was statistically significant between 3 and 6 [RD = 4.95% (95% CI = 3.49–6.41%), P < 0.0001] and 6 and 12 months [RD = 3.00% (95% CI = 2.36%–3.64%), P < 0.0001)] for medications combined and individual medications.ConclusionsThe proportion of smokers who use smoking cessation medications who benefit from doing so decreases during the course of the first year, but a net benefit still remains at 12 months.

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Section: Discussionmentioning

confidence: 99%

Diminishing benefit of smoking cessation medications during the first year: a meta‐analysis of randomized controlled trials

et al. 2018

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“…One general criticism of assisted smoking cessation is that the vast majority of ex‐smokers quit without assistance 49. According to the Eurobarometer 2012, 76% of ex‐smokers in the EU27 and 75% of ex‐smokers in Germany quit without assistance 50.…”

Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

Huber¹,

Präger²,

Coyle

et al. 2017

Addiction

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AimsTo evaluate costs, effects and cost‐effectiveness of increased reach of specific smoking cessation interventions in Germany.DesignA Markov‐based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health‐care perspective (extended to include out‐of‐pocket payments) with life‐time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates.SettingGermany.ParticipantsCohort of current smoking population (18+ years) in Germany.InterventionsInterventions included group‐based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group‐based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England.MeasurementsEQUIPTMOD considered reach, intervention cost, number of quitters, quality‐of‐life years (QALYs) gained, cost‐effectiveness and return on investment.FindingsThe highest returns through reduction in smoking‐related health‐care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group‐based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost‐savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return‐on‐investment estimates. At a hypothetical willingness‐to‐pay threshold of only €5000, the probability of being cost‐effective is approximately 75% for prospective scenario 1.ConclusionsIncreasing the reach of group‐based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost‐effective.

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“…In one line of thinking, support is undesirable because it makes people unnecessarily dependent on caregivers or the pharmaceutical industry. The empirical backing of this argument is that 'unaided cessation is by far the most common method used by most successful ex-smokers' (Chapman and MacKenzie, 2010). Other researchers claim, however, that external support increases success and that non-assisted attempts too often end in disappointment for the individual quitter (West et al, 2010).…”

Section: Expected and Experienced Roles And Activities In A Vaccinatementioning

confidence: 99%

Lifestyle Vaccines and Public Health: Exploring Policy Options for a Vaccine to Stop Smoking

Wolters

Wert

Schayck

et al. 2016

Public Health Ethics

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The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences

Abstract: Simon Chapman and Ross MacKenzie review the evidence and argue that health promotion messages should emphasize that the most successful method used by most ex-smokers is unassisted cessation.

Cited by 215 publications

References 59 publications

Diminishing benefit of smoking cessation medications during the first year: a meta‐analysis of randomized controlled trials

Diminishing benefit of smoking cessation medications during the first year: a meta‐analysis of randomized controlled trials

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

Lifestyle Vaccines and Public Health: Exploring Policy Options for a Vaccine to Stop Smoking

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