title: Enhancing tobacco quitline effectiveness: identifying a superior pharmacotherapy adjuvant.
abstract: BACKGROUND
  Telephone tobacco quitlines are effective and are widely used, with more than 500,000 U.S. callers in 2010. This study investigated the clinical effectiveness and cost-effectiveness of 3 different quitline enhancements: combination nicotine replacement therapy (NRT), longer duration of NRT, and counseling to increase NRT adherence.
  
  
  METHODS
  In this study, 987 quitline callers were randomized to a combination of quitline treatments in a 2 × 2 × 2 factorial design: NRT duration (2 vs. 6 weeks), NRT type (nicotine patch only vs. patch plus nicotine gum), and standard 4-call counseling (SC) versus SC plus medication adherence counseling (MAC). The primary outcome was 7-day point-prevalence abstinence (PPA) at 6 months postquit in intention-to-treat (ITT) analyses.
  
  
  RESULTS
  Combination NRT for 6 weeks yielded the highest 6-month PPA rate (51.6%) compared with 2 weeks of nicotine patch (38.4%), odds ratios [OR] = 1.71 (95% confidence interval [CI]:1.20-2.45). A similar result was found for 2 weeks of combination NRT (48.2%), OR = 1.49 (95% CI: 1.04-2.14) but not for 6 weeks of nicotine patch alone (46.2%), OR = 1.38 (95% CI: 0.96-1.97). The MAC intervention effect was nonsignificant. Cost analyses showed that the 2-week combination NRT group had the lowest cost per quit ($442 vs. $464 for 2-week patch only, $505 for 6-week patch only, and $675 for 6-week combination NRT).
  
  
  CONCLUSIONS
  Combination NRT for 2 or 6 weeks increased 6-month abstinence rates by 10% and 13%, respectively, over rates produced by 2 weeks of nicotine patch when offered with quitline counseling. A 10% improvement would potentially yield an additional 50,000 quitters annually, assuming 500,000 callers to U.S. quitlines per year.
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. sss@ctri.medicine.wisc.edu
authors.forename: Stevens S
authors.initials: SS
authors.lastname: Smith
authors.forename: Paula A
authors.initials: PA
authors.lastname: Keller
authors.forename: Kate H
authors.initials: KH
authors.lastname: Kobinsky
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Baker
authors.forename: David L
authors.initials: DL
authors.lastname: Fraser
authors.forename: Terry
authors.initials: T
authors.lastname: Bush
authors.forename: Brooke
authors.initials: B
authors.lastname: Magnusson
authors.forename: Susan M
authors.initials: SM
authors.lastname: Zbikowski
authors.forename: Timothy A
authors.initials: TA
authors.lastname: McAfee
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fiore
mesh_terms: D000328:Adult; D002638:Chewing Gum; D003362:Cost-Benefit Analysis; D003376:Counseling; D005260:Female; D015277:Hotlines / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000191:economics / Q000627:therapeutic use*; D010349:Patient Compliance; D012907:Smoking / Q000191:economics / Q000628:therapy*; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*; D013689:Telephone; D013997:Time Factors; D061485:Tobacco Use Cessation Devices / Q000592:standards*; D016896:Treatment Outcome; D014922:Wisconsin; D062789:Tobacco Products
chemical_list: D002638:Chewing Gum; D009538:Nicotine