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NICE backtracks on 'countdown to quit' NRT

By Nigel Praities

GPs have criticised NICE's smoking cessation guidance, after the institute reversed its decision to recommend NRT for people wanting to cut down rather than immediately quit.

NICE signalled support for the use of NRT in smokers involved in so-called ‘count down to quit' programmes in draft guidance last year. But despite emerging evidence that these programmes are cost effective, they have been dropped from the final NICE guidance after experts criticised them as sending the wrong message to smokers.

Dr Paul Aveyard, a GP in Solihull and a member of the guideline development group at NICE, said the evidence showed there was a place for NRT in helping smokers cut down

‘If you look at people who are reducing smoking, they are more likely to end up a quitter in a year or two time than a person who is not reducing smoking.

But Dr Aveyard's support for a broadening of NRT use was blocked by colleagues, due to concerns that smokers who were potential quitters could be side-tracked by programmes encouraging them to cut down rather than quit.

‘Taking all the evidence together, my own personal view would be that it would be safe decision to recommend NRT-assisted reduction for people on the NHS. However, not everyone agreed with me,' he said.

A Health Technology Assessment released last month, jointly conducted by Dr Aveyard for NICE, showed NRT to help smokers cut down was ‘highly cost-effective' in helping them go on and quit.

Dr Alex Bobak, a GP in Wandsworth, London and GPSI in smoking cessation, said: ‘This advice from NICE is not particularly helpful. It takes away opportunities from stop smoking services. I think this is a medical problem that should be dealt with on the NHS and this option should be kept alive,' he said.

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