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NICE Underpinning Review
The NHS stop smoking service (SSS) which provides evidence based treatment for smokers who seek help is achieving long-term abstinence rates of approximately 15%. There are many commercial smoking cessation treatments available outside SSS that quote success rates many times higher. There are also numerous treatments not yet fully established which may hold promise. This review assesses the current evidence for the effectiveness of nine smoking cessation interventions that are not provided by the NHS: Acupuncture, Allen Carr’s Easyway, hypnosis, NicoBloc, Nicobrevin, St. Johns Wort, aversive smoking, cytisine, and glucose.
Because there is variation in the proportions of smokers in different groups that are able to stop smoking without help, demonstration of efficacy of a class of intervention designed to aid smoking cessation requires experimental studies involving a comparison group, ideally with random allocation to the treatment of interest and to the comparison group. In addition, the definition of ‘success’ can vary widely depending on the criteria adopted, so it is essential to specify clearly the basis on which it is calculated. Finally, for a smoking cessation method to be regarded as effective, it has to increase abstinence over an extended period of time, with 6-months after stopping smoking date considered as the benchmark.
On this basis, this rapid review suggests that acupuncture, St. John's Wort and NicoBloc are probably not effective. There is insufficient evidence to determine the effectiveness of Allen Carr’s Easyway Programme and Nicobrevin. Hypnosis has not been found to be more effective than simple advice. Studies of glucose show mixed evidence of efficacy. Rapid smoking may have some efficacy, but its implementation within the contemporary treatment formats is problematic. Cytisine (Tabex) also shows evidence of efficacy. In addition, its pharmacology is understood, there is consistency of evidence with a related compound recently licensed for use in the US, it has been licensed as a smoking cessation treatment in central and eastern Europe for more than 40 years, and it costs a fraction of other current pharmacotherapies.