This additional information describes in detail the effectiveness evidence and cost information on behavioural interventions for smoking cessation. The selection of the effectiveness evidence had following steps: the literature search, selection of effectiveness evidence, and quality appraisal. The effectiveness evidence is gathered from Stead et al. (2013), Stead et al. (2017), Rice et al. (2017), Matkin et al. (2019) and Tzelepis et al. (2019). Effectiveness information for individual intervention will be updated when meta-analysis is completed. Table 3 describes studies included in those meta-analyses. «Stead LF, Buitrago D, Preciado N, ym. Physician ad...»1, «Stead LF, Carroll AJ, Lancaster T. Group behaviour...»2, «Rice VH, Heath L, Livingstone-Banks J, ym. Nursing...»3, «Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telep...»4, «Tzelepis F, Paul CL, Williams CM, ym. Real-time vi...»5
Source of the effectiveness evidence:
Literature search and selection
The literature search included network meta-analyses, meta-analyses and systematic reviews of behavioural interventions for smoking cessation. Information specialist conducted the literature search in October 2022. The timeframe for the search was years 2018–2022. The search found 47 references. We searched for the most recent evidence by viewing only network meta-analyses published in 2022 and 2021, if satisfactory number of comprehensive studies were found. Only one network meta-analysis (Hartmann-Boyce et al. 2021) «Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Men...»6 was published in 2022 and 2021 «Description of the network meta-analysis by Hartmann-Boyce et al. (2021) of behavioural interventions for smoking cessation and the suitable meta-analyses included the network meta-analysis. ...»1. The Hartmann-Boyce et al. (2021) «Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Men...»6 searched for Cochrane Reviews of behavioural interventions for smoking cessations but compared only the effectiveness of different components of behavioural interventions. Thus, the results did not represent effectiveness of the interventions. We used Hartmann-Boyce et al. (2021) «Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Men...»6 to find suitable meta-analyses of the behavioural interventions. The publication included 33 reviews and the primary outcome measure was smoking cessation at six months or longer from baseline.
Citation | Research aim | Number of trials, date of literature search | Interventions | Comments |
---|---|---|---|---|
Hartmann-Boyce et al. 2021 «Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Men...»6 |
To summarise the evidence from Cochrane Reviews that assessed the effect of behavioural interventions designed to support smoking cessation attempts and to conduct a network meta- analysis to determine how different components of behavioural interventions for smoking cessation influence the likelihood of achieving abstinence six months after attempting to stop smoking. | 312 RCTs from 33 reviews. July 2020. |
Behavioural interventions for smoking cessation. Components of the interventions were grouped to motivational, behavioural, delivery mode, intervention provider and intensity of the intervention components and compared to minimal intervention. | Comprehensive, but unclear if the results of separate components of the interventions could be used together. Therefore, only used to find suitable meta-analyses of the interventions. |
Suitable meta-analyses from Hartmann-Boyce et al. 2021 | ||||
Stead et al. 2013 «Stead LF, Buitrago D, Preciado N, ym. Physician ad...»1 | To evaluate the effectiveness of advice from medical practitioners in promoting smoking cessation. |
26 studies. February 2013. | Brief advice vs no intervention (or usual care) | Includes intervention selected by the Current Care working group compared to no intervention. |
Stead et al. 2017 «Stead LF, Carroll AJ, Lancaster T. Group behaviour...»2 | To evaluate the effectiveness of group-delivered behavioural interventions in achieving long-term smoking cessation. |
66 studies. May 2016. | Group counselling programme vs face-to-face individual intervention. Group counselling programme vs no intervention. |
Includes intervention selected by the Current Care working group compared to no intervention. |
Rice et al. 2017 «Rice VH, Heath L, Livingstone-Banks J, ym. Nursing...»3 | To evaluate the effectiveness of nursing-delivered smoking cessation interventions in adults. | 44 studies. January 2017. | Cessation interventions delivered by nurses vs. no intervention | Includes intervention selected by the Current Care working group compared to no intervention. |
Matkin et al. 2019 «Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telep...»4 | To evaluate the effectiveness of telephone support to help smokers quit, including proactive or reactive counselling, or the provision of other information to smokers calling a helpline. | 104 studies. May 2018. | Telephone counselling as an adjunct to self-help material or to a minimal intervention vs. self-help material or minimal intervention. | Includes intervention selected by the Current Care working group compared to self-help or to a minimal intervention. |
Tzelepis et al. 2019 «Tzelepis F, Paul CL, Williams CM, ym. Real-time vi...»5 | To evaluate the effectiveness of real-time video counselling delivered individually or to a group in increasing smoking cessation, quit attempts, intervention adherence, satisfaction and therapeutic alliance, and to provide an economic evaluation regarding real‐time video counselling. | 2 studies. August 2019. | Real-time video counselling vs. telephone counselling. | Includes intervention selected by the Current Care working group compared to telephone counselling. Indicates that real-time video counselling and telephone counselling interventions does not differ in effectiveness. |
We selected five meta-analyses (Matkin et al. 2019; Rice et al. 2017; Stead et al. 2013; 2017; Tzelepis et al.) for further examination of the effectiveness of behavioural interventions as they evaluated the Current Care working group's selected interventions. Stead et al. (2013) «Stead LF, Buitrago D, Preciado N, ym. Physician ad...»1 evaluated physician brief advice compared to no intervention or usual care. Stead et al. (2017) «Stead LF, Buitrago D, Preciado N, ym. Physician ad...»1 evaluated group counselling programme compared to no intervention and group counselling programme compared to face-to-face individual intervention. Rice et al. (2017) «Rice VH, Heath L, Livingstone-Banks J, ym. Nursing...»3 evaluated nurse-delivered cessation interventions compared to no interventions. Matkin et al. (2019) «Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telep...»4 evaluated telephone counselling as an adjunct to self-help materials or to a minimal intervention compared to self-help materials or minimal intervention. Tzelepis et al. (2019) «Tzelepis F, Paul CL, Williams CM, ym. Real-time vi...»5 evaluated real time video counselling compared to telephone counselling.
Quality of the selected meta-analyses
We evaluated the quality of the Stead et al. (2013) «Stead LF, Buitrago D, Preciado N, ym. Physician ad...»1 and (2017) «Stead LF, Carroll AJ, Lancaster T. Group behaviour...»2, Rice et al. (2017) «Rice VH, Heath L, Livingstone-Banks J, ym. Nursing...»3, Matkin et al. 2019 «Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telep...»4, Tzelepis et al. (2019) «Tzelepis F, Paul CL, Williams CM, ym. Real-time vi...»5 meta-analyses by using AMSTAR 2 «Shea BJ, Reeves BC, Wells G, ym. AMSTAR 2: a criti...»7. The results of the quality appraisal are shown in table «Critical appraisal of selected meta-analyses by using AMSTAR 2 ...»2.
The chosen meta-analyses were suitable base of our effectiveness evidence as they were the most comprehensive and included interventions that was selected by the Current Care working group. All but Tzelepis et al. (2019) «Tzelepis F, Paul CL, Williams CM, ym. Real-time vi...»5 had some weaknesses. Most of the trials in Stead et al. (2017) «Stead LF, Carroll AJ, Lancaster T. Group behaviour...»2 had unclear risk of bias and the meta-analysis did not evaluate how it impacted the summary estimates of effect. Rice et al. (2017) «Rice VH, Heath L, Livingstone-Banks J, ym. Nursing...»3 included all RCTs regardless of the RoB and did not discuss the likely impact of the RoB on the results. In Stead et al. (2013) «Stead LF, Buitrago D, Preciado N, ym. Physician ad...»1 and (2017) «Stead LF, Carroll AJ, Lancaster T. Group behaviour...»2 study selection was not performed in duplicate for all review versions. In both of the most recent update, the selection was done in duplicate. In Matkin et al. (2019) «Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telep...»4 there was no mention that study selection was performed in duplicate. Rice et al. 2017 «Rice VH, Heath L, Livingstone-Banks J, ym. Nursing...»3 and Matkin et al. (2019) «Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telep...»4 did not describe timeframe for follow up.
Question | Stead et al. 2013 «Stead LF, Buitrago D, Preciado N, ym. Physician ad...»1 | Stead et al. 2017 «Stead LF, Carroll AJ, Lancaster T. Group behaviour...»2 | Rice et al. «Rice VH, Heath L, Livingstone-Banks J, ym. Nursing...»3 | Matkin et al. 2019 «Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telep...»4 | Tzelepis et al. 2019 «Tzelepis F, Paul CL, Williams CM, ym. Real-time vi...»5 | |||||
---|---|---|---|---|---|---|---|---|---|---|
Answer | Comments | Answer | Comments | Answer | Comments | Answer | Comments | Answer | Comments | |
Did the research questions and inclusion criteria for the review include the components of PICO? | Yes | Yes | Yes | Yes | Yes | |||||
Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? | No | Protocol not accessible but protocol publication date provided. Unclear if review question, a search strategy, inclusion/exclusion criteria and a risk of bias assessment were stated in the protocol. | No | Protocol not accessible but protocol publication date provided. Unclear if review question, a search strategy, inclusion/exclusion criteria and a risk of bias assessment were stated in the protocol. | No | Protocol not accessible but protocol publication date provided. Unclear if review question, a search strategy, inclusion/exclusion criteria and a risk of bias assessment were stated in the protocol. | No | Protocol not accessible but protocol publication date provided. Unclear if review question, a search strategy, inclusion/exclusion criteria and a risk of bias assessment were stated in the protocol. | Yes | |
Did the review authors explain their selection of the study designs for inclusion in the review? | Yes | Yes | Yes | Yes | Yes | |||||
Did the review authors use a comprehensive literature search strategy? | Yes | Yes | Yes | Yes | Yes | |||||
Did the review authors perform study selection in duplicate? | No | Unclear if study selection was performed in duplicate in previous versions. For update in 2013, the selection was done in duplicate. | No | Study selection was not performed in duplicate for all review versions. For update in 2017, the selection was done in duplicate. | Yes | No | Unclear if study selection was performed in duplicate. | Yes | ||
Did the review authors perform data extraction in duplicate? | Yes | Yes | Yes | Yes | Yes | |||||
Did the review authors provide a list of excluded studies and justify the exclusions? | Yes | Yes | Yes | Yes | Yes | |||||
Did the review authors describe the included studies in adequate detail? | Partial yes | Does not describe interventions and comparators in detail. | Partial yes | Does not describe interventions and comparators in detail. | Partial Yes | Does not describe timeframe for follow up. | Partial Yes | Does not describe timeframe for follow up. | Yes | |
Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? | Partial yes | Selective reporting in studies not assessed. | Partial yes | Selective reporting in studies not assessed. | Partial Yes | Selective reporting in studies not assessed. | Partial Yes | Selective reporting in studies not assessed. | Yes | |
Did the review authors report on the sources of funding for the studies included in the review? | No | Study did not report the sources of funding of the included studies. | No | Study did not report the sources of funding of the included studies. | Yes | Yes | Yes | |||
If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? | Yes | Yes | Yes | Yes | Yes | |||||
If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis? | Yes | No | Included variable RoB studies and did not study how the pooled estimate of variable RoB studies impacted on summary estimates of effect. | Yes | Yes | Yes | ||||
Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review? | Yes | Yes | No | Included all RCTs regardless of the RoB and did not discuss the likely impact of the RoB on the results. | Yes | Yes | ||||
Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? | Yes | Yes | Yes | Yes | Yes | |||||
If they performed quantitative synthesis, did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? | No | Did not perform graphical or statistical tests for publication bias and discuss the likelihood and magnitude of impact of publication bias. | No | Did not perform graphical or statistical tests for publication bias and discuss the likelihood and magnitude of impact of publication bias. | Yes | Yes | Yes | |||
Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review? | Yes | Yes | Yes | Yes | Yes | |||||
Summary of the quality | Yes n=10 Partial yes n=2 No n=4 |
Yes n=9 Partial yes n=2 No n=5 |
Yes n=12 Partial yes n=2 No n=2 |
Yes n=12 Partial yes n=2 No n=2 |
Yes n=16 Partial yes n=0 No n=0 |
RCT= randomized controlled trial, RoB = risk of bias
The effectiveness evidence
Stead et al. (2013) «Stead LF, Buitrago D, Preciado N, ym. Physician ad...»1 included 17 RCTs comparing minimal intervention delivered by physician to no intervention. Minimal intervention was defined as advice which was provided during a single consultation lasting less than 20 minutes plus up to one follow-up visit. Minimal interventions did not include additional pharmacotherapies. Stead et al. (2017) «Stead LF, Carroll AJ, Lancaster T. Group behaviour...»2 included 9 RCTs comparing Group intervention vs. no intervention. The interventions included scheduled meetings and some form of behavioural intervention, such as information, advice and encouragement or cognitive behavioural therapy (CBT) delivered over at least two sessions. Rice et al. (2017) «Rice VH, Heath L, Livingstone-Banks J, ym. Nursing...»3 included 58 studies in their review. A total of 44 studies compared a nursing intervention to a control or usual care. Nursing intervention was defined as offering advice, counseling and/or strategies to aid people quit smoking. This analysis will be updated in fall 2023 and the results will be used in the table.
Matkin et al. (2019) «Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telep...»4 included 104 RCT studies in their review. Of these, 35 RCTs were used to examine the effectiveness of telephone counseling as an in addition to self-help or a minimum intervention. Telephone counselling was defined as a behavioral intervention to help people stop smoking. It can be used either alone or in combination with other therapies. Tzelepis et al. (2019) «Tzelepis F, Paul CL, Williams CM, ym. Real-time vi...»5 included 2 RCTs comparing real-time video counselling compared with telephone counselling. Real-time video counselling consists of a video camera connected to a computer or mobile device, to securely transmit live video and audio of the counsellor and client to one another over the Internet. Interventions were delivered by therapist or counsellor. The effectiveness of real-time video counseling for quitting smoking is not well supported by the available research. According to the available studies, there is no difference between telephone and video counseling. However, the results should be interpreted cautiously.
Three meta-analyses [Rice et al. 2017; Stead et al. 2013; 2017] included tobacco smokers but excluded trials of pregnant women. Additionally, Stead et al. (2017) «Stead LF, Carroll AJ, Lancaster T. Group behaviour...»2 excluded studies recruiting only adolescent smokers. Matkin et al. (2019) «Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telep...»4 included studies in which participants were mostly adult smokers from the general population, but some studies included also teenagers, pregnant women, and people with long term or mental health conditions. Tzelepsis et al. (2019) «Tzelepis F, Paul CL, Williams CM, ym. Real-time vi...»5 had no age, gender, nicotine dependency, or comorbidities limitations. All meta-analyses required the follow-up for smoking cessation outcome at least six months after the start of treatment.
The selected reviews reported RRs and 95%CIs for the Current Care working group's selected interventions. We converted the RRs to NNTs «Schünemann HJ, Vist GE, Higgins JPT, Santesso N, D...»8. Assumed comparator risk (5%) was the pooled result of the 58 RCT's minimal intervention or no intervention groups' smoking cessation in 6-months «Rice VH, Heath L, Livingstone-Banks J, ym. Nursing...»3.
The resource use and costs of interventions
We searched for information about the resource use and cost of intervention for five different interventions: minimal intervention (short intervention), group intervention, individual intervention, telephone counselling and real time video counselling. Information about the use of resources is based on meta-analyses [Matkin et al. (2019); Rice et al. (2017); Stead et al. 2013; 2017; Tzelepis et al. (2019)]. If the information was lacking, we searched for it from original studies. The resource use of the individual intervention will be gathered from updated meta-analyses (Rice et al. 2017). We looked for information on the number of appointments, the time use, the provider of the intervention and the possible size of the group if the intervention was delivered in group format [table 3]. Table 3 describes the average number of sessions, time use per session, total time use of the sessions and the most usual provider of the interventions in the original studies. Also, the table describes corresponding numbers used in cost calculation assumed by the Current Care working group to represent Finnish practice. We used the Finnish unit costs for physician and public health nurse (Mäklin & Kokko, 2021) «Mäklin, S., & Kokko, P. (2021). Terveyden- ja sosi...»9 converted to 2021 value using the Statistics Finland's public expenditure price index (2023) «Official Statistics of Finland (OSF): Price index ...»10. Unit prices for professionals were converted to represent cost per minute by assuming 30-minute appointments. Cost of interventions represent the intervention costs per patient.
From meta-analyses | Used in cost analysis | |||||||
---|---|---|---|---|---|---|---|---|
Intervention | Number of sessions | Time use per session | Total time use of the sessions | Provider | Number of sessions | Time use per session | Total time use of the sessions | Provider |
Mini-intervention (Stead et al. 2013) «Stead LF, Buitrago D, Preciado N, ym. Physician ad...»1 | 1.2 (md=1) | 3.6 min | 3.6 min (md=2) | Physician | 1 | 4 min | 4 min | Physician |
Individual intervention* | Nurse | 60 min | Public health nurse | |||||
Group intervention (Stead et al. 2017) «Stead LF, Carroll AJ, Lancaster T. Group behaviour...»2 | 7.9 (md=7), group size 12.4 | 81.9 min | 643 min (md=600) | Nurse | 8 (group size 10) | 90 min | 720 min | Public health nurse |
Telephone counselling (Matkin et al. 2019) «Tzelepis F, Paul CL, Williams CM, ym. Real-time vi...»5 | 4.6 (md=4) | 15 min | 69 min (md=45) | Counsellor | 3 | 15 min | 45 min | Public health nurse |
*Individual intervention: meta-analysis is in process.