title: Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development.
abstract: OBJECTIVE
  This paper provides a concise review of the efficacy, effectiveness and affordability of health-care interventions to promote and assist tobacco cessation, in order to inform national guideline development and assist countries in planning their provision of tobacco cessation support.
  
  
  METHODS
  Cochrane reviews of randomized controlled trials (RCTs) of major health-care tobacco cessation interventions were used to derive efficacy estimates in terms of percentage-point increases relative to comparison conditions in 6-12-month continuous abstinence rates. This was combined with analysis and evidence from 'real world' studies to form a judgement on the probable effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on World Health Organization (WHO) criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of saving a life-year was less than or equal to the per-capita gross domestic product for that category of country.
  
  
  RESULTS
  Brief advice from a health-care worker given opportunistically to smokers attending health-care services can promote smoking cessation, and is affordable for countries in all World Bank income categories (i.e. globally). Proactive telephone support, automated text messaging programmes and printed self-help materials can assist smokers wanting help with a quit attempt and are affordable globally. Multi-session, face-to-face behavioural support can increase quit success for cigarettes and smokeless tobacco and is affordable in middle- and high-income countries. Nicotine replacement therapy, bupropion, nortriptyline, varenicline and cytisine can all aid quitting smoking when given with at least some behavioural support; of these, cytisine and nortriptyline are affordable globally.
  
  
  CONCLUSIONS
  Brief advice from a health-care worker, telephone helplines, automated text messaging, printed self-help materials, cytisine and nortriptyline are globally affordable health-care interventions to promote and assist smoking cessation. Evidence on smokeless tobacco cessation suggests that face-to-face behavioural support and varenicline can promote cessation.
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.affiliation: Special Lecturer, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Raw
authors.affiliation: Professor of Tobacco Addiction, King's College London, UK Centre for Tobacco and Alcohol Studies, National Addiction Centre, London, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: McNeill
authors.affiliation: Cochrane Tobacco Addiction Group, Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Stead
authors.affiliation: Professor of Behavioural Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
authors.affiliation: Professor of Epidemiology, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
authors.forename: John
authors.initials: J
authors.lastname: Bitton
authors.affiliation: Reader in Addiction Statistical Analysis, Addictions Department, Institute of Psychiatry, Kings College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Stapleton
authors.affiliation: Reader in Public Health Interventions, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
authors.forename: Hayden
authors.initials: H
authors.lastname: McRobbie
authors.affiliation: Health Economics Research Group, Brunel University London, Uxbridge, UK.
authors.forename: Subhash
authors.initials: S
authors.lastname: Pokhrel
authors.affiliation: LeLan Ltd, Bristol, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Lester-George
authors.affiliation: Cancer Council Victoria, Melbourne, Victoria, Australia.
authors.forename: Ron
authors.initials: R
authors.lastname: Borland
mesh_terms: D006287:Health Planning Guidelines; D006293:Health Promotion / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D014029:Tobacco Use Disorder / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States
keywords: Affordability; NRT; behavioural support; brief interventions; cytisine; effectiveness; efficacy; interventions; smoking cessation; tobacco cessation