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The waiting game

NRT benefits all smokers, not just quitters

By Nigel Praities

GPs may be required to give nicotine replacement therapy to all smokers, regardless of whether or not they intend to quit, after a systematic review found it was still cost-effective even in these patients.

Current NICE guidance recommends NRT for smokers who make a commitment to stop smoking on or before their target stop date. But a Health Technology Assessment commissioned by NICE, found NRT use remained cost effective for smokers unable to quit in the short term, but who may cut down over an extended period with support.

Just over five per cent of people taking part in so-called ‘cut down to quit' programmes ended up quitting compared with 2.6% of those on placebo making them ‘highly cost-effective', according to the review.

But the authors cautioned that a CDTQ approach was less cost-effective than an abrupt quit and should only be used in patients who would not otherwise try to stop smoking. At 12 months, quit rates with CDTQ were 5.3%, compared with 16% of those who had an abrupt quit.

The findings may influence the updated NICE guidance on NRT, due later this month. A source close to the discussions said plans to recommend CDTQ in the final version had proven ‘controversial'.

Dr Tim Lancaster, a GP in Oxford and co-ordinating editor of the Cochrane tobacco addiction review group, said he had not found CDTQ approaches to work.

‘The motivation, which is a key thing, is going to be much stronger in people willing to stop and want to cut down,' he said. Dr Lancaster recommended GPs tried other options, such as varenicline or bupropion, before CDTQ.

‘I would never advise that as the first step of a strategy. It would only be for people who had real problems with quitting and you were wanting to minimise harm and have yet another go,' he said.

Smoking woman

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