Ken Wassum, Director, Clinical & Quality Support
Telephone tobacco quitlines have helped hundreds of thousands American and Canadian smokers quit over the past 20 years. Now we have good evidence for new use of old tools to boost success among smokers trying to quit, saving lives and many years of misery due to smoking-related ill health. This data shows increased quit rates of 10% to 13% using this new approach.
Nicotine replacement therapy (NRT) has been around since the mid-eighties, and when paired with support from well trained tobacco treatment specialists (like our own Quit Coaches), it has consistently increased quit success compared with those who do not use it. In recent years combinations of NRT, where short-acting forms of NRT like the gum and lozenge are paired with the longer-acting nicotine patch, have been shown to further increase success in quitting. However, until just recently we did not have data from randomized controlled trials showing that combined NRT is effective in Quit Line settings. Now we do.
In a recently published article in Nicotine and Tobacco Research titled "Enhancing Tobacco Quitline Effectiveness: Identifying a Superior Pharmacotherapy Adjuvant," Dr. Stevens Smith and his team at the Wisconsin Center for Tobacco Research and Intervention tested two different regimens of combined patch and gum against two regimens of the patch alone in services delivered by the Wisconsin Tobacco Quitline which is operated by Alere Wellbeing.
In conjunction with the Alere Wellbeing quitline counseling protocol, those who were randomly assigned to either 2 weeks of nicotine patch plus gum or 6 weeks of nicotine patch plus gum did much better than those who received the patch alone. Using 7-day point prevalence at 6 months measurements in which those who could not be reached for follow-up assessment were counted as being not quit (Intent-to-Treat), smokers who received either of the combined patch and gum regimens demonstrated 51.6% and 48.2% quit rates, respectfully. In comparison, among those receiving 6 weeks or 2 weeks of patch-only yielded a 46.2% and 38.4% quit rate, respectively.
Due to budget constraints many state quitlines have reduced their NRT offering to 2 weeks of either patch or gum, frequently called starter kits. Using the 2-week regimen of patch-only as the control group, the 6-week combined NRT group showed a 13% increase and the 2-week combined NRT group showed a 10% increase over those in the control group. Importantly, the 2-week combined NRT regimen was also the most cost-effective at $442 per quit.
The conclusions of the study were that if quitlines were to cover combination NRT it would help an additional 30,000 to 50,000 tobacco users quit each year. Callers to tobacco quitlines operated by Alere Wellbeing have received encouragement from Quit Coaches to combine the patch and gum for several years now, but the cost of the second form of NRT has presented a barrier to low income, uninsured callers. While state tobacco quitlines continue to face reduced budgets, combination NRT presents a highly cost-effective way to increase quit rates and reduce lives lost to tobacco use.
Ken Wassum has been treating tobacco users for over 19 years. He is past President of The Association for the Treatment of Tobacco Use and Dependence and previously served on its Board of Directors. Join him as he blogs about the effects of the tobacco epidemic, the efforts of cessation advocates, and the work left for us to rid the world of nicotine addiction. Read