Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults

Michael V. Maciosek; Amy B. LaFrance; Steven P. Dehmer; Dana A. McGree; Zack Xu; Thomas J. Flottemesch; Leif I. Solberg

doi:10.1370/afm.2022

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Applying Evidence-Based Medicine for Smoking Cessation in Primary Care
Juliana N. Pfeil

Published on: 20 February 2017

Published on: (20 February 2017)
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Applying Evidence-Based Medicine for Smoking Cessation in Primary Care
Juliana N. Pfeil, Professor
Other Contributors:
Smoking cessation counselling, described by Maciosek et al.[1] as a cost-saving strategy that deserves to be prioritized, is of great importance for the southern Brazilian city of Porto Alegre. The prevalence of smoking in Porto Alegre is 14.9%, higher than the national prevalence of 10.4%.[2] To address that, our primary care unit, which covers a population of about 40 thousand in the city, launched in 2005 a cognitive-b...
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Smoking cessation counselling, described by Maciosek et al.[1] as a cost-saving strategy that deserves to be prioritized, is of great importance for the southern Brazilian city of Porto Alegre. The prevalence of smoking in Porto Alegre is 14.9%, higher than the national prevalence of 10.4%.[2] To address that, our primary care unit, which covers a population of about 40 thousand in the city, launched in 2005 a cognitive-behavioral group program with weekly meetings. The meetings, lasting 1.5-2 hours each, are provided free of charge and follow Ministry of Health guidelines.[3] There is evidence that this kind of community approach has contributed to a 10% decline in the prevalence of smoking in Brazil in the past 20 years.[4]
At our unit, an open model was implemented: patients may join the group at any time and attend as many meetings as they themselves deem necessary. Patients are taught techniques for smoking cessation and management of the urge or crave to smoke (including mindfulness), and are encouraged to share their own experience with other participants. Nicotine patches and bupropion are provided free of charge according to the stage of dependence and comorbidities. With this, we achieved a success rate of 87.5% in individuals attending 4 or more meetings in 2016.
This group program costs about 700 dollars (2,194.20 Brazilian reais) annually. Considering 275 meetings and 35 patients who quit smoking, the cost is about 20 dollars per quitter per year. The cost of traditional (individual) consultations for the same number of patients would be around 1,400.00 per year (about 40.00 dollars per patient annually). This kind of evaluation is essential to guide priorities and ensure more effective health care.[5]
Inspired by the advantages of youth counseling evidenced by Maciosek et al.,[2] we are now developing an educational intervention for public schools to guide young people not to start smoking. Any intervention aiming to decrease smoking rates is positive, and new approaches should always be put into practice when there is evidence of their benefits.
1. Maciosek MV, LaFrance AB, Dehmer SP, et al. Health benefits and cost-effectiveness of brief clinician tobacco counseling for youth and adults. Ann Fam Med. 2017;15(1):37-47. doi: http://doi.org/10.1370/afm.2022
2. Brazil, Ministerio da Saude. Datasus: mortalidade proporcional por grupos de causas por regiao do Brasil. http://tabnet.datasus.gov.br/cgi/deftohtm.exe?idb2011/c04.def. Accessed 17 Oct 2016.
3. Brazil, Ministerio da Saude. Instituto Nacional de Cancer. Coordenacao Nacional de Controle do Tabagismo e Prevencao Primaria do Cancer. Abordagem e tratamento do fumante. Consenso 2011. Rio de Janeiro: INCA; 2011.
4. Levy D, de Almeida LM, Szklo A. The Brazil SimSmoke Policy Simulation Model: The effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation. PLoS Med. 2012;9(11). doi: http://doi.org/10.1371/journal.pmed.1001336
5. Stange KC. In this issue: powerful ideas for action. Ann Fam Med. 2017;15(1):2-4. doi: http://doi.org/10.1370/afm.2024
Competing interests: None declared
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Competing Interests: None declared.