Enhancing Tobacco Quitline Effectiveness: Identifying a Superior Pharmacotherapy Adjuvant.

Smith SS, Keller PA, Kobinsky KH, Baker TB, Fraser DL, Bush T, Magnusson B, Zbikowski SM, McAfee TA, Fiore MC. Nicotine Tob Res. 2013 Mar;15(3):718-28.

This study examined the effectiveness and cost-effectiveness of three different quitline enhancements: combination (two at once) nicotine replacement therapy (NRT), longer duration of NRT, and counseling to help people use NRT the way it was intended (adherence). 987 quitline callers were randomized to a combination of treatments in a 2x2x2 factorial design: NRT duration (2 vs. 6 weeks), NRT type (patch only vs. patch plus gum), and standard counseling (SC) vs. SC plus medication adherence counseling (MAC). Results showed that patch plus gum for six weeks produced the highest 6-month point prevalence abstinence (PPA) quit rates (51.6%) compared to two weeks of patch (38.4%). The MAC intervention effect was nonsignificant. The two-week patch plus gum group had the lowest cost per quit ($442 vs. $464 for two-week patch only, $505 for six-week patch only, and $675 for six-week patch plus gum). The authors conclude that providing both patch and gum for two or six weeks with quitline counseling increased six-month quit rates by 10% and 13% respectively over rates produced by providing two weeks of patches alone with quitline counseling. If all US quitlines increased their effectiveness by 10%, an additional 50,000 smokers would quit each year, assuming 500,000 call quitlines annually.