NHS statistics on stop-smoking services in Scotland were published yesterday. We take a more detailed look at the long-term success rates of these services.
Do they offer good value for money?
‘Smoking cessation’, or in normal language ‘stopping smoking’ is something we’re naturally very interested in at ASH Scotland. We provide training on it, work with others to publish guidance on it, and we collate and publish research about it.
Yesterday, NHS Information Services Division published their annual report (pdf) of service statistics on Scotland’s stop smoking services. These figures are useful, because they let us see how many, and what type of people quit smoking with these (free, through the NHS) services, and how this picture has changed over time. This data release shows that more quit attempts were made through services in 2012 (116,198) than 2011 (112,812), continuing the increasing trend seen in recent years. Good news.
But the important thing of course is not just how many people ‘attempt’ to quit, it is how many actually do go on to quit. From today’s data, 38% of those who make a quit attempt are still non-smokers at one month (see the graph below). Over time this decreases to 16% at 3 months, and around 6% at one year.
[Image of graph taken from NHS ISD Scotland report.]
Now, a critical view we sometimes hear is ‘well, if only 6% have quit at 12 months, that doesn’t sound like a very good service to me’. You might be tempted to agree with this, but there are several other factors to weigh into the judgement here.
One is that all clients who haven’t been able to be contacted (the green bars in the graph above, nearly 70% at 12 months) are counted as smokers. This probably isn’t the case in reality: many will be non-smokers as a result of the support, but just haven’t been around to receive the 12 month follow-up phone call or didn’t reply to other attempts at contact, such as by letter.
If the success rates in those who were ‘lost to follow-up’ were the same as those contactable, then the overall quit rates at one year would be more like 18%. However, this might be too high – you could pretty reasonably argue that people who weren’t able to be contacted are less likely to be successfully quit than those who were able to be contacted (negative feelings about their lack of quit success meaning they avoided contact with the follow-up service).
In a study of somewhat similar services in England with very comprehensive follow up, researchers found one-year quit outcomes of 15% to 18% (depending on whether you are happy with a ‘self-reported’ quit, or one that has been validated by carbon monoxide). So it seems quite likely the ‘true’ success rates in Scotland are going to be similar – maybe not as high as 18%, but certainly higher than 6%.
Now if you are being (even more) critical, you could say ‘well, even 15% doesn’t sound like a very good success rate to me, if I take antibiotics or go for major surgery I want a success rate of 95% plus, why shouldn’t I get this if I go to a NHS-funded stop smoking service?’
Unfortunately there are no easy answers at this point – the reality is that cigarette smoking is addictive, stopping for good can be difficult, and after a (relatively short) smoking cessation intervention people go back into everyday life where there are many cues that can trigger relapse to smoking again. This is why only around 3% to 5% of ‘unassisted’ quit attempts are successful at one year. However, because the ‘unassisted’ chances of success are (unfortunately) quite low, even stop smoking support that increases one year success rates by what appears to be a quite modest amount, to 15% (though bear in mind this is actually a four-fold or so increase), is the most effective support we know about. It also turns out that, because of this, when you examine how much it costs the NHS, it works out to be very cost-effective to provide.
If you are interested in getting advice or assistance to stop smoking in Scotland and giving your quit attempt the best chance of success, have a look at canstopsmoking.com