Trial Information

Efficacy and Cost of State Quitline Policies

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:

1. 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.

2. 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.

3. 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).

4. Determine the incremental cost per year-of-life saved for the alternative policies
relative to usual care.