The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline.
OBJECTIVE
State and national tobacco quitlines have expanded rapidly and offer a range of services. We examined the effectiveness and cost effectiveness of offering callers single session versus multisession counselling, with or without free nicotine patches.


METHODS
This 3x2 randomised trial included 4614 Oregon tobacco quitline callers and compared brief (one 15-minute call), moderate (one 30-minute call and a follow-up call) and intensive (five proactive calls) intervention protocols, with or without offers of free nicotine patches (nicotine replacement therapy, NRT). Blinded staff assessed tobacco use by phone at 12 months.


RESULTS
Abstinence odds ratios were significant for moderate (OR = 1.22, CI = 1.01 to 1.48) and intensive (OR = 1.29, CI = 1.07 to 1.56) intervention, and for NRT (OR = 1.58, CI = 1.35 to 1.85). Intent to treat quit rates were as follows: brief no NRT (12%); brief NRT (17%); moderate no NRT (14%); moderate NRT (20%); intensive no NRT (14%); and intensive NRT (21%). Relative to brief no NRT, the added costs for each additional quit was $2467 for brief NRT, $1912 for moderate no NRT, $2109 for moderate NRT, $2641 for intensive no NRT, and $2112 for intensive NRT.


CONCLUSIONS
Offering free NRT and multisession telephone support within a state tobacco quitline led to higher quit rates, and similar costs per incremental quit, than less intensive protocols.
Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA. Jack.Hollis@kpchr.org
Jack F
JF
Hollis
Timothy A
TA
McAfee
Jeffrey L
JL
Fellows
Susan M
SM
Zbikowski
Michael
M
Stark
Karen
K
Riedlinger
D000328:Adult; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics / Q000379:methods*; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D015277:Hotlines / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000627:therapeutic use*; D009922:Oregon; D018579:Patient Selection; D016037:Single-Blind Method; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*; D000074606:Smoking Prevention; D013689:Telephone; D014029:Tobacco Use Disorder / Q000628:therapy*
D009538:Nicotine