Efficacy and Cost of State Quitline Policies

Study Overview
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Brief Summary
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State-sponsored anti-tobacco campaigns are motivating large numbers of smokers to seek advice, assistance, and support to make their cessation efforts more successful. Like many states, Oregon has sponsored the implementation of a statewide telephone quitline to provide information, referrals, and cessation support for callers. This study will answer key policy questions about how to most effectively support smokers who call the Oregon Quitline for assistance. The specific aims are to recruit 4,500 callers to participate in a 3 x 2 randomized trial comparing the cost and cost effectiveness of three levels of behavioral intervention. We will also test two different policies on the availability of nicotine patch therapy. Subjects will be interviewed by telephone at 6 and 12 months to assess smoking status, quit attempts, and use of health plan anc community cessation services. Costs will be assessed separately from the perspectives of the patients, health plans, the State (i.e., Oregon Quitline), and society. Cost per quit and cost per year quality-adjusted years of life saved will be calculated from each of these perspectives.

Detailed Description
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Anti-tobacco media campaigns in many states are motivating large numbers of smokers to seek advice, assistance, and support to make their cessation efforts more successful. Like many other states, Oregon has sponsored the implementation of a statewide telephone quitline to provide information, referrals, and cessation support for callers. Two investigators on this proposal (Hollis and McAfee) have a contract with the State of Oregon to provide the Oregon Quitline (OQL) services. The purpose of the proposed research effort is to collaborate further with State representatives to answer key policy questions about how to most effectively support smokers who call the OQL for assistance. Our overall aim is to recruit 4,500 callers to the OQL to participate in a 3 x 2 randomized trial to compare the cost and cost effectiveness of three levels of behavioral intervention. We will also test two different policies regarding the availability of nicotine patch therapy. Subjects will be interviewed by telephone at 6 and 12 months to assess smoking status, quit attempts, and use of health plan and community cessation services. Costs will be assessed separately from the perspective of the patients, health plan, the State (i.e., OQL), and society. The specific aims are described below: Compare the efficacy of three policies for supporting OQL callers: Brief counseling with referral to caller's health plan cessation services (standard service); Moderate counseling, referral to health plan, and one follow-up call to reinforce use of health plan services; Moderate counseling, referral, and availability a multi-session telephonic intervention. Compare the efficacy of two policies regarding the provision of nicotine replacement: No offer of nicotine replacement (current policy); An offer of free nicotine replacement patches. Determine the costs and cost per quit of the additional policy interventions relative to usual care (i.e., standard service) from the following perspectives: Societal perspective (total incremental costs per incremental quit); State perspective (incremental cost per quit for OQL services); Health plan perspective (based on differences in use of health plan cessation services); Participant's perspective (based on differences in out-of-pocket expenses). Determine the incremental cost per year-of-life saved for the alternative policies relative to usual care.

Official Title
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Efficacy and Cost of State Quitline Policies

Conditions
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Smoking Cessation, Tobacco Use Cessation, Cost-effectiveness

Intervention / Treatment
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* Behavioral: Multi-session telephone counseling
* Drug: NRT patches


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18+ Speak English or Spanish Oregon resident Smoke 5 or more cigarettes/day Planning to quit within 30 days (or quit within in last 7 days) Consent to random assignment and follow-up Exclusion Criteria: Health plan benefit includes free multi-session telephone counseling Current or planned pregnancy or breast-feeding Heart attack within the preceding month.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Multi-session telephone counseling|nan|
|Drug: NRT patches|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participant self-reported 30 day abstinence from any tobacco at 6 and 12 months, assuming intent to treat. |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participant self-reported (at 6 and 12 months) any tobacco use by type |  |  | 
| amount used per day |  |  | 
| stage of change |  |  | 
| number of quit attempts |  |  | 
| use of health plan and community cessation resources |  |  | 
| intervention total cost, cost per participant, and cost per quit |  |  | 
| incremental cost effectiveness ratios for each intervention compared to baseline |  |  | 
| patterns of pharmacotherapy use |  |  | 
| out-of-pocket expenses for cessation activities. |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cessation, Smoking, Quitline, Policies, Counseling