Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.17 - Tobacco Use Cessation Therapies
(2013; 42 pages)


Smoking is considered the single most important cause of preventable morbidity and premature mortality worldwide. Tobacco addiction caused about 100 million deaths during the 20th century, each year 5.4 million people die from this cause, and if resolute and urgent action is not taken by 2030 the epidemic will cause between 8 and 10 million deaths each year, of which over 80% occur in low- and middle-income countries (LMIC).

Stopping smoking is very difficult; often require repeated intervention and/or multiple attempts to quit. Nowadays, there are numerous effective medications available for tobacco dependence. In general, seven first-line medications (five nicotine and two non-nicotine) are recommended and reliably increase long-term smoking abstinence rates. Based on this evidence, clinicians should encourage their use in patients attempting to quit smoking except when medical contraindication exists or with specific populations (i.e. pregnant women, smokeless tobacco users, light smokers, and adolescents) for which there is insufficient evidence of effectiveness.

The research currently available suggests that abstinence rates can be increased by combining different forms of nicotine replacement therapy (NRT) or simultaneous administration of NRT and non-nicotinic compounds. However, more research is needed in this area, as well as a better definition of the criteria which need to be fulfilled to use some of the therapeutic modalities in combination. Additionally, evidence suggests that smokers who relapse sometimes during their cessation attempt are at high risk of future relapses, so that rescue interventions for smokers are necessary.

More research is needed on the cost-effectiveness of pharmacotherapy for smoking cessation in LMIC to inform decision makers about the need for the development of lower costs therapeutic options for their countries.

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