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Treatment use patterns in a large extended-treatment tobacco cessation program: predictors and cost implications
  1. Scott Veldhuizen1,
  2. Laurie Zawertailo1,2,3,
  3. Aliya Noormohamed1,
  4. Sarwar Hussain1,
  5. Peter Selby1,3,4,5,6
  1. 1Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  2. 2Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  3. 3Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  4. 4Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  6. 6Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Peter Selby; peter.selby{at}


Background Tobacco dependence follows a chronic and relapsing course, but most treatment programmes are short. Extended care has been shown to improve outcomes. Examining use patterns for longer term programmes can quantify resource requirements and identify opportunities for improving retention.

Methods We analyse 38 094 primary care treatment episodes from a multisite smoking cessation programme in Ontario, Canada that provides free nicotine replacement therapy (NRT) and counselling. We calculate distributional measures of weeks of NRT used, clinical visits attended and total length of care. We then divide treatment courses into four exclusive categories and fit a multinomial logistic regression model to measure associations with participant characteristics, using multiple imputation to address missing data.

Results Time in treatment (median=50 days), visits (median=3) and weeks NRT used (median=8) were well below the maximum available. Of all programme enrolments, 28.8% (95% CI=28.3% to 29.3%) were single contacts, 31.3% (30.8% to 31.8%) lasted <12 weeks, 19.2% (18.8% to 19.6%) were ≥12 weeks with an 8-week interruption and 20.7% (20.3%–21.1%) were ≥12 weeks without interruptions. Care use was most strongly associated with participant age and whether the nicotine patch was dispensed at the first visit.

Conclusion Treatment use results imply that the marginal costs of extending treatment programmes are relatively low. The prevalence of single contacts supports additional engagement efforts at the initial visit, while interruptions in care highlight the ability of longer term care to address relapse. Results show that use of the nicotine patch is associated with retention in care, and that improving engagement of younger patients should be a priority.

  • cessation
  • primary health care
  • economics

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  • Contributors SV analysed the data and drafted and revised the paper. He is the guarantor. PS and LZ initiated and supervised the study and revised the draft paper. AN and SH managed the study, supervised data collection and revised the draft paper.

  • Funding This work was supported by the Ontario Ministry of Health (grant number HLTC5047FL). PS is also supported by the Centre for Addiction and Mental Health and by the Clinician Scientist programme at Department of Family and Community Medicine, University of Toronto.

  • Disclaimer The funder had no role in study design, data collection and analysis, interpretation of findings, preparation of this manuscript or decision to submit for publication.

  • Competing interests PS has the following general disclosures to report: grants and/or salary and/or research support from the Centre for Addiction and Mental Health, Health Canada, Ontario Ministry of Health and Long-term Care (MOHLTC), Canadian Institutes of Health Research (CIHR), Canadian Centre on Substance Use and Addiction, Public Health Agency of Canada (PHAC), Ontario Lung Association, Medical Psychiatry Alliance, Extensions for Community Healthcare Outcomes, Canadian Cancer Society Research Institute (CCSRI), Cancer Care Ontario, Ontario Institute for Cancer Research, Ontario Brain Institute, McLaughlin Centre, Academic Health Sciences Centre, Workplace Safety and Insurance Board, National Institutes of Health (NIH), and the Association of Faculties of Medicine of Canada. PS also reports receiving funding and/or honoraria from the following commercial organisations: Pfizer/Canada, Shoppers Drug Mart, Bhasin Consulting Fund, Patient-Centered Outcomes Research Institute, ABBVie and Bristol-Myers Squibb. Further, PS reports receiving consulting fees from Pfizer Canada, Evidera, Johnson & Johnson Group of Companies, Medcan Clinic, Inflexxion, V-CC Systems, MedPlan Communications, Kataka Medical Communications, Miller Medical Communications, Nvision Insight Group and Sun Life Financial. Through an open tender process Johnson & Johnson, Novartis and Pfizer are vendors of record for providing smoking cessation pharmacotherapy, free or discounted, for research studies in which PS is the principal investigator or co-investigator.

  • Patient consent for publication Not required.

  • Ethics approval The STOP Programme's procedures were approved by the Research Ethics Board at the Centre for Addiction and Mental Health. Participants provided informed, written consent for use of data for research at the time of the baseline interview.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data analysed during the current study are available from the corresponding author on reasonable request.