Cessation in the use of tobacco - pharmacologic and non-pharmacologic routines in patients.

INTRODUCTION: Approximately one-third of the adult population in industrial countries and 70% in several Asian countries are daily smokers. Tobacco is now regarded as the world's leading cause of death. Approximately two-thirds of lifelong smokers eventually die because of smoking. Smoking cessation is the most effective action to reduce mortality in patients with chronic obstructive pulmonary disease (COPD) and coronary heart disease. OBJECTIVE: The aim of this study was to determine the effectiveness of smoking cessation programmes in patients with smoking-related disorders. METHODS: Medline was searched for studies of interventions for smoking cessation in patients. RESULTS: In patients with cardiovascular diseases and COPD, smoking cessation programmes with behavioural support over several months significantly increase quit rates. The intensity of the programmes seems to be proportional to the effect. A long follow-up period is probably the most important element in the programmes. Even the most intensive programmes are very cost-effective in terms of cost per life-year gained. Effective programmes can be delivered by personnel without special education in smoking cessation using simple intervention principles. CONCLUSIONS: In patients with smoking-related disorders, smoking cessation interventions with several months of follow-up are effective and easily applicable in clinical practice. Wider implementation of such programmes would be a cost-effective way of saving lives.

Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease.

BACKGROUND: Smoking cessation is probably the most important action to reduce mortality after a coronary event. Smoking cessation programs are not widely implemented in patients with coronary heart disease, however, possibly because they are thought not to be worth their costs. Our objectives were to estimate the cost effectiveness of a smoking cessation program, and to compare it with other treatment modalities in cardiovascular medicine. METHODS: A cost-effectiveness analysis was performed on the basis of a recently conducted randomized smoking cessation intervention trial in patients admitted for coronary heart disease. The cost per life year gained by the smoking cessation program was derived from the resources necessary to implement the program, the number needed to treat to get one additional quitter from the program, and the years of life gained if quitting smoking. The cost effectiveness was estimated in a low-risk group (i.e. patients with stable coronary heart disease) and a high-risk group (i.e. patients after myocardial infarction or unstable angina), using survival data from previously published investigations, and with life-time extrapolation of the survival curves by survival function modeling. RESULTS: In a lifetime perspective, the incremental cost per year of life gained by the smoking cessation program was euro 280 and euro 110 in the low and high-risk group, respectively (2000 prices). These costs compare favorably to other treatment modalities in patients with coronary heart disease, being approximately 1/25 the cost of both statins in the low-risk group and angiotensin-converting enzyme inhibitors in the high-risk group. In a sensitivity analysis, the costs remained low in a wide range of assumptions. CONCLUSIONS: A nurse-led smoking cessation program with several months of intervention is very cost-effective compared with other treatment modalities in patients with coronary heart disease.