Cost effectiveness of computer tailored and non-tailored smoking cessationletters in general practice: randomised controlled trial

Objectives To develop and evaluate, in a primary care setting, a computeris ed system for generating tailored letters about smoking cessation. Design Randomised controlled trial. Setting Six general practices in Aberdeen, Scotland. Participants 2553 smokers aged 17 to 65. Interventions All participants received a questionnaire asking about their smoking Participants subsequently received either a computer tailored or a non-tailored, standard letter on smoking cessation, or no letter. Main outcome measures Prevalence of validated abstinence at six months; cha nge in intention to stop smoking in the next six months. Results The validated cessation rate at six months was 3.5% (30/857) (95% c onfidence interval 2.3% to 4.7%) for the tailored letter group, 4.4% (37/84 6) (3.0% to 5.8%) for the non-tailored letter group, and 2.6% (22/850) (1.5 % to 3.7%) for the control (no letter) group. After adjustment for signific ant covariates, the cessation rate was 66% greater (-4% to 186%; P = 0.07) in die non-tailored letter group than that in the no letter group. Among pa rticipants who smoked < 20 cigarettes per day, the cessation rate in the no n-tailored letter group was 87% greater (0% to 246%; P = 0.05) than that in the no letter group. Among heavy smokers who did not quit, a 76% higher ra te of positive shift in "stage of change" (intention to quit within a parti cular period of time) was seen compared with those who received no letter ( 11% to 180%; P = 0.02). The increase in cost for each additional quitter in the non-tailored letter group compared with the no letter group was <pound >89. Conclusions In a large general practice, a brief non-tailored letter effect ively increased cessation rates among smokers. A tailored letter was not ef fective in increasing cessation rates but promoted shift in movement toward s cessation ("stage of change") in heavy smokers. As a pragmatic tool to en courage cessation of smoking, a mass mailing of non-tailored letters from g eneral practices is more cost effective than computer tailored letters or n o letters.