There are a variety of smoking cessation interventions which are used with individual smokers. These include Nicotine Replacement Therapy; other pharmacological treatments; alternative therapies, brief advice; individual counselling; and group counselling. In addition there are a range of other kinds of interventions such as mass media campaigns and community-based activities which are designed to reduce the prevalence of smoking in the general population. The evidence regarding the effectiveness and cost-effectiveness of these interventions is discussed below.
Nicotine Replacement Therapy (NRT) has been shown to be effective in the treatment of tobacco withdrawal and dependence. Numerous clinical trials have shown that NRT (gum, patches or nasal spray) increases smokers' chances of remaining abstinent from cigarettes for a year by between 50-100% (Foulds & Jarvis 1995). At the time of writing, a new NRT product - the nicotine inhaler - has come onto the market but as yet there is little available evidence about its effectiveness.
It is estimated that NRT is effective for 13% of smokers who seek help in cessation, with an increased efficacy for those with higher levels of nicotine dependency (Law & Tang 1995). Studies also suggest that the vast majority of smokers who are going to succeed in quitting following a brief intervention with nicotine patches achieve abstinence within the first week of quitting. Therefore, it may only be appropriate for a doctor to continue to prescribe nicotine replacement to those who managed to achieve abstinence using the product within the first week (Foulds 1996). Thus, the use of NRT can be viewed as a short-term support mechanism.
The research also highlights the importance of matching the intensity of the intervention to the smoker's levels of motivation and addiction. For example light smokers might not require NRT when attempting to stop smoking whilst the most dependent smokers might need NRT provided within a specialist support setting. (Appendix Two)
The cost effectiveness of Nicotine Replacement Therapy compares favourably with that of other interventions. The NHS cost of a course of NRT treatment (3 weeks maximum) is £24. With success rates of 13%, and those not abstinent after 1 week ending treatment, the cost to the NHS per successful quitter would be £80. If NRT were made available on prescription and 10% of the Scotland's 1.4 million adult smokers attempt to give up smoking per annum, then 18,200 smokers would achieve abstinence at an estimated cost to the NHS of £1.5 million (Appendix Five). After five years of NRT being available on prescription 91,000 smokers would have been helped to stop. Assuming no other major change in the prevalence of smoking, this would give a 6.5% reduction in the prevalence of smoking at an estimated cost to the NHS of £7.5 million.
Law & Tang have also reviewed of a range of other pharmacological interventions and 'alternative' therapies. Analysing data from 188 randomised controlled trials, they conclude that other pharmacological treatments - such as clonidine hydrochloride, tranquilisers, buspirone hydrochloride and naloxone - are not of proven efficacy. They also show that acupuncture is ineffective and that the effectiveness of hypnosis is not proven (Law & Tang 1995).