Enhancing Tobacco Quitline Effectiveness: Identifying a Superior Pharmacotherapy Adjuvant
Enhancing Tobacco Quitline Effectiveness: Identifying a Superior Pharmacotherapy Adjuvant
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DOI：
10.1093/ntr/nts186
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发表时间：
2013-03-01
影响因子：
4.7
通讯作者：
Fiore, Michael C.
中科院分区：
文献类型：
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作者：
Smith, Stevens S.;Keller, Paula A.;Fiore, Michael C.
电话戒烟热线是有效的，并被广泛使用，2010年美国有超过50万人拨打电话。本研究调查了3种不同戒烟增强措施的临床有效性和成本效益：联合尼古丁替代疗法（NRT）、更长的NRT持续时间和增加NRT依从性的咨询。在这项研究中，987名戒烟热线呼叫者随机接受22 2析因设计的戒烟热线治疗组合：NRT持续时间（2周vs. 6周），NRT类型（仅尼古丁贴片vs.贴片+尼古丁口香糖），标准4次电话咨询（SC）vs. SC+药物依从性咨询（MAC）。主要结果是意向治疗（ITT）分析中戒烟后6个月的7天时点戒烟率（PPA）。与尼古丁贴片2周（38.4%）相比，NRT联合治疗6周产生了最高的6个月PPA率（51.6%），比值比[OR] 1.71（95%置信区间[CI]：1.202.45）。2周联合NRT（48.2%）的结果相似，OR 1.49（95% CI：1.042.14），但6周单独尼古丁贴片（46.2%）的结果不相似，OR 1.38（95% CI：0.961.97）。MAC干预效果不显著。成本分析显示，2周联合NRT组每次戒烟的成本最低（442美元，仅2周贴剂464美元，仅6周贴剂505美元，6周联合NRT 675美元）。联合NRT 2周或6周分别使6个月的戒烟率增加10%和13%，高于2周尼古丁贴片与戒烟热线咨询的戒烟率。假设每年有50万人拨打美国戒烟热线，10%的改善可能会使每年增加5万人戒烟。
: 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.: In this study, 987 quitline callers were randomized to a combination of quitline treatments in a 22 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.: 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]:1.202.45). A similar result was found for 2 weeks of combination NRT (48.2%), OR 1.49 (95% CI: 1.042.14) but not for 6 weeks of nicotine patch alone (46.2%), OR 1.38 (95% CI: 0.961.97). 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).: 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.