Free Nicotine Patches Plus Phone Counseling Prompts More Smokers to Quit

Portland, Oregon, Nov. 30

Smoking cessation rates doubled when quit-line callers were given free nicotine patches in addition to counseling, researchers found.

Calls to a smoking cessation hotline increased 112% when, in addition to a 30-minute telephone counseling session, callers were given a two-week supply of transdermal nicotine patches, said Jeffrey Fellows, Ph.D., of the Kaiser Permanente Center for Health Research here, and colleagues.

Quit rates also improved from 8.2% with counseling alone to 15.7% with the patches plus counseling, they reported in a December supplement to the journal Tobacco Control.

In a separate randomized trial, more than 21% of smokers quit when they received intensive counseling plus nicotine patches, versus 11.7% among smokers who received a single brief counseling session and no patches.

Portland, OregonDr. Fellows noted that offering free nicotine replacement ultimately reduces the “average cost per quit.” In the first program, he said, the total one-year cost for counseling alone was $1.97 million versus $2.25 million when the patch giveaway was added. However, the addition of patches quadrupled the number of smokers who quit, so the cost per quit was $1,050 with the patch giveaway compared with $3,778 without it.

More than 2,100 smokers in the first program quit with the patches during the yearlong analysis; only 527 had quit with counseling alone the previous year. Quitting was defined as at least 30 days of tobacco abstinence at a six-month follow-up interview.

Another factor that may have contributed to the difference was free publicity surrounding the patch giveaway, raising awareness of the smoking quit-line service, the authors said.

“Given persistent resource limitations, state tobacco control program managers should consider reallocating portions of their media promotion budget to cover medications,” they said.

The second program, a prospective parallel-group trial in which some 4,600 quit-line callers were assigned randomly to six levels of service, showed similar effectiveness for patch giveaways.

The services included: brief counseling (one 15-minute call) with or without nicotine patches, moderate counseling (one 30-minute call and one follow-up call) with or without patches, or intensive counseling (one 30-minute call and four follow-up calls) with or without patches.

Subjects were contacted after one year to determine the results. As in the first study, if they had not used tobacco in the last 30 days, they were determined to have quit successfully.

They were also asked at follow-up to rate the quit-line service. Among those who received intensive counseling plus patches, 92.5% said they were satisfied, compared with 53.9% of those assigned to brief counseling alone.

As in the first study, the more intensive services were more cost-effective despite the greater expense per caller. Brief counseling alone cost $67 per caller versus $268 for intensive counseling plus nicotine patches. Relative to brief counseling alone, the costs for each additional quit in the other levels of service were similar, with a cost of $1,912 for moderate counseling and no patches and $2,112 per incremental quit for intensive counseling plus patches.

Although GlaxoSmithKline supplied patches without charge, the researchers included the usual price of patches in their cost calculations.

“Policymakers for state quit-lines might choose to offer only brief counseling with no [nicotine replacement therapy] because the cost per caller is lower,” said Jack Hollis, Ph.D., of Kaiser and lead author of the second study.

“However,” he said, “our results suggest that higher quit rates, greater client satisfaction, and the potential to attract more smokers to quit-lines more than offset the modest additional costs. Heavily addicted smokers, who have the highest health care costs over time, may benefit even more from intensive counseling and medication.”

All U.S. states have quit-line services, ranging from a single telephone session to counseling with multiple follow-up calls and nicotine replacement therapy.
The first study was supported by the Oregon Tobacco Prevention and Evaluation Program and the CDC.The second study was supported by a grant from the National Cancer Institute. GlaxoSmithKline provided the nicotine patches. Drs. Fellows and Hollis reported no conflicts of interest. Their co-authors included employees of Free & Clear Inc., the company providing the quit-line service in Oregon.

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Primary source: Tobacco Control

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