Effectiveness of smoking cessation program in health service units in Nakhon Ratchasima Province
Keywords:smoking cessation, varenicline
Tobacco smoking is the leading health risk factor for burden of diseases in Thailand. The study on economic burden of smoking-related diseases in Thailand in 2014 found that 55,000 died from diseases caused by smoking (accounting for 11.2% of all deaths). Significant efforts led by the World Health Organization (WHO) and several countries have resulted in the development and introduction of clinical practice guidelines for medical personnel to help smokers quit, particularly in developing countries. The objective of this study was to evaluate the effectiveness of the smoking cessation program consisting of administration of varenicline as an aid to smoking cessation therapy in combination with counseling at the level of health service units in Nakhon Ratchasima Province. This prospective case-control study involved a 12- week treatment period with follow-up of the smoking status of all participants at 14th day, 12th week and 24th week. A total of 2,000 current smokers were enrolled from October 2017 - July 2018 at 32 hospitals and health promotion centers in Nakhon Ratchasima Province, Thailand. Subjects were included if they were >15 years old, smoked regularly at least one year prior to study, and desired to quit smoking. Exclusion criteria were psychiatric patients and those who used illicit drugs. Intervention group consisted of 1,000 subjects with heavy smoking or had chronic non-communicable diseases (NCDs) such as diabetes, heart disease, chronic obstructive pulmonary disease (COPD), or smokers who failed from previous quitting efforts and wanted to quit smoking. and the intervention group received varenicline and counseling services. Comparative group included other 1,000 smokers who wanted to quit smoking and this control group received only counseling services to quit smoking. Results showed that smoking cessation rate at 24 weeks (6 months) was significantly higher in the experiment group (39.3%) than in the comparative group (15.3%) (OR = 3.58 95% CI (2.89, 4.44), p<0.001). Conclusions: The study provides information on the effectiveness of different interventions between varenicline and counseling or counseling only in smoking cessation clinic at health service units in Thailand. When compared to counseling only, varenicline prescription along with counseling was 2-3 times more effective at both hospital and hospital and health promotion center levels in Nakhon Ratchasima Province. To improve effectiveness of smoking cessation program, medication along with counseling should be considered by public health authority as appropriate treatment option for patients, if clinically indicated.
Burden of Disease Research Program Thailand (BOD Thailand). Thailand burden of diseases attributable to risk factors 2014. Bangkok: International Health Policy Program; 2018. (in Thai)
Bundhamcharoen K, Aungkulanon S, Makka N, Shibuya K. Economic burden from smoking-related diseases in Thailand. Tob Control 2016;25:532-7.
Thavorncharoensap M, Woothisai T, Leelahavarong P, Praditsitthikorn N, Deebukkham P, Rattanavipapong W, et al. Development of guideline for setting goal and indicators for evaluating the operation of health promotion programs of the Thai health promotion foundation using cost-of-illness information. Bangkok: Health Systems Research Institute; 2011. (in Thai)
Preechawong S, Nuchsongsin F, Pittayarangsarit S. Reviews on effectiveness of smoking cessation interventions among patients with chronic diseases. J Public Health 2015;45:324-33. (in Thai)
International Health Policy Program, Thailand. Report on policy recommendation to improve drug lists for smoking cessation. Nonthaburi: International Health Policy Program; 2016. (in Thai)
Kongsakon R, Sruamsiri R. A cost-utility study of smoking cessation interventions for patients with chronic obstructive pulmonary disease in Thailand. J Med Assoc Thai 2019;102:463-71.
Bae JY, Kim CH, Lee E, Evaluation of cost-utility of varenicline compared with existing smoking cessation therapies in South Korea. Value Health 2009;12 Suppl 3:S70-3.
Igarashi A, Takuma H, Fukuda T, Tsutani K. Cost-utility analysis of varenicline, an oral smoking-cessation drug, in Japan. Pharmacoeconomics 2009;27:247-61.
Mahmoudi M, Coleman CI, Sobieraj DM. Systematic review of the cost-effectiveness of varenicline vs. bupropion for smoking cessation. Int J Clin Pract 2012;66:171-82.
Bolin K, Mörk A, Willers S, Lindgren B. Varenicline as compared to bupropion in smoking-cessation therapy-cost–utility results for Sweden 2003. Respir Med 2008;102:699-710.
Bolin K, Wilson K, Benhaddi H, de Nigris E, Marbaix S, Mork A, et al. Cost-effectiveness of varenicline compared with nicotine patches for smoking cessation--results from four European countries. Eur J Public Health 2009;19:650-4.
Wang C, Xiao D, Chan KP, Pothirat C, Garza D, Davies S. Varenicline for smoking cessation: a placebo-controlled, randomized study. Respirology 2009;14:384-92.
Tsai ST, Cho HJ, Cheng HS, Kim CH, Hsueh KC, Billing CB Jr, et al. A randomized, placebo-controlled trial of varenicline, a selective alpha4Beta2 nicotinic acetylcholine receptor partial agonist, as a new therapy for smoking cessation in Asian smokers. Clin Ther 2007;29:1027-39.
Tosanguan J, Chaiyakunapruk N. Cost-effectiveness analysis of clinical smoking cessation interventions in Thailand. Nonthaburi: The International Health Policy Program, Thailand; 2010. (in Thai)
Seesin T. Efficacy and safety of medications use in tobacco dependence. Isan Journal of Pharmaceutical Sciences 2014;10:256-68. (in Thai)
Minphimai W, Waleekhachonloet O, Limwattananon S, Limwattananon C. Meta-analysis of smoking cessation medications on continuous abstinence rate at 1 year. Isan Journal of Pharmaceutical Sciences 2015;11 Suppl:145-50. (in Thai)
Rigotti NA, Pipe AL, Benowitz NL, Arteaga C, Garza D, Tonstad S. Efficacy and safety of varenicline for smoking cessation in patients with cardiovascular disease: a randomized trial. Circulation 2010;121:221-9.
Lock K, Wilson K, Murphy D, Riesco JA. A cost-effectiveness model of smoking cessation based on a randomised controlled trial of varenicline versus placebo in patients with chronic obstructive pulmonary disease. Expert Opin Pharmacother 2011;12:2613-26.
Tashkin DP, Rennard S, Hays JT, Ma W, Lawrence D, Lee TC. Effects of varenicline on smoking cessation in patients with mild to moderate COPD: a randomize controlled trial. Chest 2011;139:591-9.
Jorenby DE, Hays JT, Rigotti NA, Azoulay S, Watsky EJ, Williams KE, et al. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA 2006;296:56-63.
Eisenberg MJ, Windle SB, Roy N, Old W, Grondin FR, Bata I, et al. Varenicline for smoking cessation in hospitalized patients with acute coronary syndrome. Circulation 2016;133:21-30.
How to Cite
Articles published in the Disease Control Journal are considered as academic work, research or analysis of the personal opinion of the authors, not the opinion of the Thailand Department of Disease Control or editorial team. The authors must be responsible for their articles.