A smoking cessation counsellor: should every hospital have one?

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Abstract
The study was performed in order to ascertain the sustained smoking cessation rate in hos pital patients who received a structured programme of advice and support from a counsel lor and to estimate the cost-effectiveness of such an intervention. Hospital in-patients and out-patients were referred by their physician/surgeon to the smoking cessation counsellor who provided advice to reinforce that of the doctor and gave support by repeated follow-up sessions, weekly in the first month and thereafter at three, six and twelve months. Of 1,155 patients referred to the counsellor, 114 (13%) failed to keep the first appointment and 348 (30%) attended for advice on one occasion only. Among the latter, the self-reported sus tained cessation rate at one year was 5%. In the 663 patients who participated in the pro gramme the validated (expired air CO) 12-month, sustained cessation rate was 21%. Allowing 7.5% success rate among patients receiving a physician's advice only, the cost of each additional success achieved as a result of the programme is £851 and the cost per life year saved is between £340 and £426. Assuming that after one year's abstinence relapse rates are relatively small, this represents a sound investment in the light of the cost of treating patients with smoking-related illnesses and compares favourably with other smoking cessa tion strategies and health care interventions.