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The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline
  1. Jack F Hollis1,
  2. Timothy A McAfee2,
  3. Jeffrey L Fellows1,
  4. Susan M Zbikowski2,
  5. Michael Stark3,
  6. Karen Riedlinger1
  1. 1
    Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
  2. 2
    Free & Clear, Inc, Seattle, WA, USA
  3. 3
    Oregon Department of Human Services, Portland, OR, USA
  1. Jack F Hollis, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA; Jack.Hollis{at}


Objectives: State and national tobacco quitlines have expanded rapidly and offer a range of services. We examined the effectiveness and cost effectiveness of offering callers single session versus multisession counselling, with or without free nicotine patches.

Methods: This 3×2 randomised trial included 4614 Oregon tobacco quitline callers and compared brief (one 15-minute call), moderate (one 30-minute call and a follow-up call) and intensive (five proactive calls) intervention protocols, with or without offers of free nicotine patches (nicotine replacement therapy, NRT). Blinded staff assessed tobacco use by phone at 12 months.

Results: Abstinence odds ratios were significant for moderate (OR = 1.22, CI = 1.01 to 1.48) and intensive (OR = 1.29, CI = 1.07 to 1.56) intervention, and for NRT (OR = 1.58, CI = 1.35 to 1.85). Intent to treat quit rates were as follows: brief no NRT (12%); brief NRT (17%); moderate no NRT (14%); moderate NRT (20%); intensive no NRT (14%); and intensive NRT (21%). Relative to brief no NRT, the added costs for each additional quit was $2467 for brief NRT, $1912 for moderate no NRT, $2109 for moderate NRT, $2641 for intensive no NRT, and $2112 for intensive NRT.

Conclusion: Offering free NRT and multisession telephone support within a state tobacco quitline led to higher quit rates, and similar costs per incremental quit, than less intensive protocols.

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  • Competing interests: JFH, JLF and KR have no competing interests. TAMcA and SMZ are with Free & Clear, Inc, which is a for-profit company providing telephone counselling services.

  • Funding: This work was supported by the National Cancer Institute (grant R01 CA86242), and we want to thank GlaxoSmithKline for supplying the nicotine patches used in the study.

  • Abbreviations:
    incremental cost effectiveness ratios
    nicotine replacement therapy
    Oregon tobacco quitline