Cost effectiveness of computer tailored and non-tailored smoking cessation letters in general practice: randomised controlled trial.
OBJECTIVE
To develop and evaluate, in a primary care setting, a computerised system for generating tailored letters about smoking cessation.


METHODS
Randomised controlled trial.


METHODS
Six general practices in Aberdeen, Scotland.


METHODS
2553 smokers aged 17 to 65.


METHODS
All participants received a questionnaire asking about their smoking. Participants subsequently received either a computer tailored or a non-tailored, standard letter on smoking cessation, or no letter.


METHODS
Prevalence of validated abstinence at six months; change in intention to stop smoking in the next six months.


RESULTS
The validated cessation rate at six months was 3.5% (30/857) (95% confidence interval 2.3% to 4.7%) for the tailored letter group, 4.4% (37/846) (3.0% to 5.8%) for the non-tailored letter group, and 2.6% (22/850) (1.5% to 3.7%) for the control (no letter) group. After adjustment for significant covariates, the cessation rate was 66% greater (-4% to 186%; P=0.07) in the non-tailored letter group than that in the no letter group. Among participants who smoked <20 cigarettes per day, the cessation rate in the non-tailored letter group was 87% greater (0% to 246%; P=0.05) than that in the no letter group. Among heavy smokers who did not quit, a 76% higher rate of positive shift in "stage of change" (intention to quit within a particular period of time) was seen compared with those who received no letter (11% to 180%; P=0.02). The increase in cost for each additional quitter in the non-tailored letter group compared with the no letter group was pound 89.


CONCLUSIONS
In a large general practice, a brief non-tailored letter effectively increased cessation rates among smokers. A tailored letter was not effective in increasing cessation rates but promoted shift in movement towards cessation ("stage of change") in heavy smokers. As a pragmatic tool to encourage cessation of smoking, a mass mailing of non-tailored letters from general practices is more cost effective than computer tailored letters or no letters.
Lennox
A S
AS
Department of General Practice and Primary Care, University of Aberdeen, Aberdeen AB25 2AY.
Osman
L M
LM
Reiter
E
E
Robertson
R
R
Friend
J
J
McCann
I
I
Skatun
D
D
Donnan
P T
PT
D000293:Adolescent; D000328:Adult; D000368:Aged; D015709:Correspondence as Topic; D003362:Cost-Benefit Analysis; D003367:Cotinine / Q000032:analysis; D001330:Electronic Data Processing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012463:Saliva / Q000737:chemistry; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*; D011795:Surveys and Questionnaires
D003367:Cotinine